ethylene glycol toxicity

Presentation. CNS depression begins soon after exposure, lasting for up to 12 hours after ingestion. Urine pH – consistently low, • Woods lamp – oral cavity, face, paws, vomitus, and urine – fluorescent sodium fluorescein" in urine up to 6h post ingestion. Please enable it to take advantage of the complete set of features! Ethylene glycol toxicity is a type of toxic leukoencephalopathy. Ethylene glycol polymers with large carbon chains may be reproductive toxins, but ethylene glycol itself exhibits no developmental toxicity or detrimental effects to reproductive health in humans. Br J Clin Pharmacol 2016; 81:505. NIH All rights reserved. Dogs:      6.6 ml/kg (other reports suggest less). • ionized calcium and electrolyte (twice daily). Ethylene glycol, hazardous substance in the household.  |  Acid metabolites (serum) in association with metabolic acidosis; decrease plasma bicarbonate ( as early as 1h post ingestion). An overdose of ethylene glycol can damage the brain, lungs, liver, and kidneys. Ethylene glycol exposures can cause varying degrees of toxicity and management generally requires supportive care, close laboratory monitoring and antidotal therapy. • Increased serum phosphorus due to decreased glomerular filtration, • Hyperkalemia with onset of oliguria and anuria. Do not use ethylene glycol if there is the possibility of ingestion or incidental contact to food and/or potable water. • Supportive care (correct fluid, acid-base, and electrolyte imbalances). Toxic metabolites of EG cause severe metabolic acidosis and renal tubular epithelial damage. The systemic toxicity of the ethylene-based glycol ethers is mediated by their metabolism to the corresponding alkoxyacetic acids. • Serum osmolality (N = 280-310 mOsm/kg) – Starts increasing 1h post ingestion; increase parallel serum EG concentrations. • It is the most toxic of similarly used alcohols (ethyl alcohol, butylene glycol and propylene glycol). Trends in toxic alcohol exposures in the United States from 2000 to 2013: a focus on the use of antidotes and extracorporeal treatments. 1988 Jan;84(1):145-52. The detailed report by Swor et al. Ethylene glycol (C2H6O2) is a toxic alcohol that is found in various household and industrial agents. J Med Toxicol 2017; 13:153. Similar to ethanol, it causes intoxication, followed by drowsiness or coma. Epub 2014 Apr 9. -. 2018 Apr;13(3):375-383. doi: 10.1007/s11739-018-1799-9. Ethylene glycol exposure can be extremely dangerous, with significant morbidity and mortality if left untreated. For institutions that frequently treat ethylene glycol toxicity cases, in-hospital rapid laboratory confirmation may become cost-effective because of the institutional cost-benefit ratio evaluation that compares therapy with fomepizole, ethanol, and hemodialysis. Reduce Ethylene glycol metabolism – Alcohol dehydrogenase Inhibitor: Although ADH induces diuresis or hyperosmolality at recommended dosage, 4-. Metabolites are cytotoxic to proximal tubular cells, resulting in the deposition of these calcium oxalate crystals (monohydrate) within the lumen of kidney tubules, thereby causing interstitial edema and their subsequent urinary excretion. Affected animals appear transiently improved, becoming worse with time. Commonly found in radiator coolants, antifreeze (concentrations>20%), de-icing solutions, solvents and brake fluids. Blood ethylene glycol levels can be detected as early as 30 minutes post ingestion. Methanol is likewise meta- bolized by a series of enzymatic reactions to formic acid, a toxic compound that can cause blindness from permanent injury to the optic nerve. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. Ethylene glycol, best known as a component of antifreeze, has been ingested both deliberately and accidentally, resulting in neurotoxicity and renal failure. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. In vitro percutaneous absorption of [14C] ethylene glycol. follow. 1,2-DIHYDROXYETHANE, 1,2-ETHANEDIOL, 1,2ETHANEDIOL, 2-HYDROXYETHANOL, ETHANE-1,2-DIOL, ETHYLENE GLYCOL, and GLYCOL J Expo Anal Environ Epidemiol. HHS Ethylene glycol is rapidly absorbed through the gastrointestinal tract, and its vapor or aerosol is absorbed through the respiratory tract. All rights reserved. 2014 Jul-Aug;27(4):395-401. doi: 10.1111/sdi.12237. Clipboard, Search History, and several other advanced features are temporarily unavailable. Exposure Summary; Environmental Fate; CERCLA Quantities; Non-Human Toxicity Values; Ecotoxicity Values; Soil Adsorption / Mobility; Volatilization; Ethylene Glycol CAS RN: 107-21-1 Density / Specific Gravity. ethylene glycol itself is relatively non-toxic -> metabolites extremely toxic (glycolate) rate limiting step = alcohol dehydrogenase activity; accumulation of glycolate -> direct cellular toxicity; CLINICAL FEATURES. In: StatPearls [Internet]. Waiting 3-4 hours or more for the ethylene glycol level to come back can be deleterious to the patient. COVID-19: LOW risk Start test. Methyl- and ethyl-substituted ethylene glycol ethers can cause bone marrow depression, testicular atrophy, developmental toxicity, and immunotoxicity in animals. Unconsciousness. Am J Med. Production of toxic metabolites (glycoaldehyde, glycolic acid, glyoxylic acid, oxalic acid, formic acid etc.) Its concentration in automotive radiator fluid is high (95%), a source to which pets (dogs and cats) have easy access. Unfortunately these products can taste sweet making them appealing to children. Notes Aldehyde metabolites lead to cytotoxicity, calcium oxalate crystal deposition and secondary cerebral edema. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Jun 26. Cats are sensitive to a lower detection limit and therefore could be positive but are not detected due to the high detection limit of this test – delayed treatment with poor outcome. Left untreated, these clinical sighs continue unchecked throughout the first 24 hours post exposure. In applications where toxicity is NOT a concern, ethylene glycol is often the heat transfer fluid of choice. Ethylene glycol is metabolized by a series of steps to gly-colic acids and oxalic acid, the latter with the potential to cause severe renal injury [2-5]. Utility of the serum osmol gap in the diagnosis of methanol or ethylene glycol ingestion. Hodgman M, Marraffa JM, Wojcik S, Grant W. Serum Calcium Concentration in Ethylene Glycol Poisoning. Non-reproductive organ system toxicity (high), Occupational hazards (high), and Contamination concerns (high) fragrance ingredient, humectant, solvent, viscosity decreasing agent, and viscosity controlling. Antidotes for poisoning by alcohols that form toxic metabolites. • Induced vomiting/gastric lavage/activated charcoal seems of questionable value since vomiting is an early clinical sign – already gotten rid of most if not all of the ingested ethylene glycol. NLM Maintain patient renal tubular regeneration, peritoneal dialysis. Ethylene glycol is a small molecule (62 dalton) which undergoes rapid absorption from the gastrointestinal tract, distributes to the liver where it is rapidly metabolized by the hepatic alcohol dehydrogenase pathway to toxic metabolites (glycoaldehyde, glycolic acid, glyoxlic acid, oxalic acid, and formic acid), and is excreted in the urine. After absorption, ethylene glycol is distributed in internal fluids. Epub 2018 Feb 9. Negative tests does not rule out EG toxicity. This molecule has been observed in outer space.  |  Ethylene glycol detection in Blood: - test kit: detection limit >50mg/dl. • Its toxic effects for a long time went un-recognized, and, in 1931 it was used medicinally as a solvent in pharmaceutical formulations. Since the metabolites rather than parent compound (ethylene glycol), are the primary toxins, toxicity is best characterized as lethal synthesis. • Infrequently observed with acidosis – a shift to the ionized, physiologically active form of calcium, • Serum glucose increases in some cases >> inhibition of glucose metabolism by aldehydes, increased epinephrine, endogenous corticosteroid, and uremia, • Little or no osmole gap increase but will for osmolality due to azotemia and hyperglycemia, • Remain isosthenuric in late stage due to renal dysfunction and impaired ability to concentrate urine, • Calcium oxalate crystalluria persist as long as animal produces urine, • Urine abnormalities – associated with renal damage – hematuria, protein urea and glucose urea, granular/cellular cell casts, WBC, RBC, renal epithelial calls, • Best to start 8h (dogs) Cats 3h post ingestion, • Aimed at preventing absorption, increasing excretion, metabolism (critical). Acidosis (acidic blood) can also be detected through the biochemistry profile. In suspected ethylene glycol toxicity time is of the essence. -, Jacobsen D, Hewlett TP, Webb R, Brown ST, Ordinario AT, McMartin KE. Ann Emerg Med 27(3):343-6. Copyright © 2020, StatPearls Publishing LLC. 1996. Approximately 50% of ingested EG is excreted unchanged by the kidneys; however, a series of oxidation reactions in the liver and kidneys metabolize the remaining EG. • The presence of these metabolites induces severe metabolic acidosis leading to metabolic changes – increased ionic gap, osmolarity, osmotic diuresis, polydipsia/polyuria, dehydration leading to calcium oxalate crystal formation. Calcium – oxalic acid interaction produces calcium oxalate crystals which are widely deposited in tubular cells and lumen. Component of antifreeze, automobile coolants, de-icing agents, industrial solvents and hydraulic brake fluid. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. Educational video on methanol and ethylene glycol toxicity. Ethylene glycol poisoning is most common in temperate and cold climates because antifreeze is used both to decrease the freezing point and to increase the boiling point of radiator fluid. Indicate exposure. Ethylene glycol is an inexpensive, readily available substance that may be associated with accidental or intentional toxicity. where they are deposited and excreted in urine. Reduce Ethylene glycol metabolism – Alcohol dehydrogenase substrate inhibitor: Ethanol has a higher affinity for alcohol dhydrogenase than ethylene glycol and would be metabolized in preference to ethylene glycol by this enzyme. McMartin K, Jacobsen D, Hovda KE. The available information on the acute and subchronic toxicity of ethylene glycol monobutyl ether is reviewed. Glaser DS. Note in cats, no polydipsia so this could be due to dehydration. Emergency departments located in larger metropolitan areas may negotiate availability of this test at regional clinical … CNS depression observed. • Ethylene glycol (mildly toxic) on ingestion is rapidly absorbed and undergoes liver metabolism via the alcohol dehydrogenase pathway. Toxic alcohol diagnosis and management: an emergency medicine review. Page 1 of 8 MSDS- Mono Ethylene glycol Material Safety Data Sheet (MSDS) - Mono Ethylene glycol 1. Clin Toxicol (Phila) 2017 Dec;55(10):1072-1252. COVID-19 is an emerging, rapidly evolving situation. Ethylene Glycol (Anti-freeze) Toxicity • Ethylene glycol is a clear, odorless, sweet to the taste, highly hygroscopic synthetic • Liquid found commonly in automotive fluids – antifreeze, coolants, and brake fluid; photographic supplies, solvents, rust removers, and taxidermist's preservative solutions to name a few. Ethylene glycol toxicity Ethylene glycol toxicity Frape, D. L. 2002-10-01 00:00:00 Ethylene glycol toxicity D. L. FRAPE The Priory, Churchyard, Mildenhall, Suffolk IP28 7EE, UK. Medical education. Am J Clin Pathol 1966; 45:46. © 2021 MJH Life Sciences™ and DVM 360. USA.gov. The toxic mechanism of ethylene glycol poisoning is mainly due to the metabolites of ethylene glycol. Ng PCY, Long BJ, Davis WT, Sessions DJ, Koyfman A. Intern Emerg Med. During this time, there is often an elevated osmolar gap without an elevated anion gap or acidosis. Am J Emerg Med. Ethylene glycol is a colorless, sweet-tasting liquid most commonly found in antifreeze, but … 2007 Sep;25(7):799-803. doi: 10.1016/j.ajem.2007.01.017. In addition, the animal exhibits polydipsia (not in cats)/polyuria, tachycardia, becomes more depressed, weak, anorectic, with rapid breathing and dyspnic. Ethylene Glycol Toxicity. Increases in Osmolality is detected as early as three hours post ethylene glycol ingestion, and, remain high for at least 18 hours, • Dogs isosthenuric (urine SG = 1.008-1.012) 3h following EG ingestion (osmotic diuresis and serum hyperosmolality-induced polydipsia: cats – decreased urine SG 3h but may be above isosathenuric range, • Cats and dogs: Calcium oxalate crystalluria – common as early as 3h (cats) - 6h (dogs) following ingestion – strong supporting diagnostic proof. Ethylene glycol (C2H6O2) is a toxic alcohol that is found in various household and industrial agents. EG is converted to glycoaldehyde by alcohol dehydrogenase ; Glycoaldehyde is metabolized to glycolic acid by aldehyde dehydrogenase ; Metabolic acidosis develops ; Glycolic acid further metabolized to oxalic acid and glycine (which eventually is converted to hippuric acid) Renal toxicity directly caused by oxalic acid metabolite 2. Ethylene glycol toxicity usually presents with a varying degree of inebriation early in the course, with the potential for central nervous system depression (CNS). 1.1135 g/cu cm AT 20 deg C . This site needs JavaScript to work properly. Hemodialysis has been attempted, renal transplantation (cats). It was implicated in 1937 as the cause of seven-six deaths in human when used as a solvent in sulfanilamide formulation. Initially it is metabolized by alcohol dehydro… Seizures may occur due to a direct effect. Range of Toxicity; Laboratory; Carcinogenicity Evidence; Environment. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. -, Driver J, Tardiff RG, Sedik L, Wester RC, Maibach HI. The gastrointestinal tract is the primary route of exposure. The impact of bittering agents on pediatric ingestions of antifreeze. -, White NC, Litovitz T, Benson BE, Horowitz BZ, Marr-Lyon L, White MK. Toxicity Summary; Range of Toxicity; Laboratory; Carcinogenicity Evidence; Environment. [ncbi.nlm.nih.gov] Entire Body System . StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2020. Early empiric ethanol therapy and consideration of dialysis are recommended for those patients with such a presentation without evidence of abnormal levels of ketones, lactate, salicylate, or ethanol. These metabolic intermediates (organic acids) induce severe metabolic acidosis, kidney failure and subsequent death, in exposed animals and humans. • Increased BUN and Creatinine (dogs 24-48h; cats 12h). • Dog: 20mg/kg IV initially, followed by 15 mg/kg IV @12 and 24h, and 5mg/kg IV @ 36h. • Cats require higher dosage than dogs (feline ADH is less effectively inhibited by 4-MP) 125mg/kg IV followed by 31.25mg/kg IV@ 12, 24, 36h. Ethylene glycol toxicity. Chemical Product and Company Identification Product Name : Mono Ethylene glycol Catalog Codes : SLE1072 CAS# : 107 -21 -1 RTECS : KW2975000 TSCA : TSCA 8(b) inventory: Ethylene glycol CI# : Not available. Beyond this point, and the condition remains untreated, renal failure develops resulting in a oliguric/anuric state, followed by death 72 hours post ethylene glycol ingestion. , Davis WT, Sessions DJ, Koyfman A. Intern Emerg Med drunk: automotive antifreeze, automobile coolants antifreeze. With ischemia, perforation, and re-crystallize within tubular lumen primary toxins, toxicity is a colorless and dihydroxyl... ( 3 ):375-383. doi: 10.1016/j.ajem.2007.01.017 • ethylene glycol toxicity associated with accidental or toxicity. ” is a collective term that includes methanol, ethylene glycol toxicity, and 5mg/kg IV 36h. Subsequent death, in exposed animals and humans calcium oxalic acid reaction forming soluble complexes which are through. 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