how to detect ethylene glycol poisoning

[30][31], Antifreeze products for automotive use containing propylene glycol in place of ethylene glycol are available, and are generally considered safer to use, as it possesses an unpleasant taste in contrast to the perceived "sweet" taste of toxic ethylene glycol-based coolants, and only produces lactic acid in an animal's body, as their muscles do when exercised. As the metabolism of ethylene glycol progresses there will be less ethylene glycol and this will decrease the blood ethylene glycol concentration and the osmolal gap making this test less useful. A toxic dose requiring medical treatment varies but is considered more than 0.1 mL per kg body weight (mL/kg) of pure substance. However, these instruments and the needed expertise are not readily available in most clinical laboratories. [73] Another study found the toxicity to aquatic and other organisms was relatively low, but the oxygen-depletion effect of biodegradation was more serious (p. Oxalate binds calcium, leading to calcium oxalate crystals, which are deposited in many tissues but are most readily detected in the urine. 12). Because hemodialysis will also remove the antidotes from the blood, doses of antidotes need to be increased to compensate. In cats, this stage occurs 12–24 hours after consuming antifreeze; in dogs, at 36–72 hours after consuming antifreeze. [55][56][57] Many cases of poisoning are the result of using ethylene glycol as a cheap substitute for alcohol or intentional ingestions in suicide attempts. Signs of ethylene glycol poisoning depend upon the time after ingestion. The disadvantage of fomepizole is that it is expensive. It does not have color or odor. [76] Considering factors such as the "seasonal nature of releases, ambient temperatures, metabolic rates and duration of exposure", Environment Canada stated in 2014 that "it is proposed that ethylene glycol is not entering the environment in a quantity or concentration or under conditions that have or may have an immediate or long-term harmful effect on the environment or its biological diversity". et al. [2], Signs of ethylene glycol poisoning depend upon the time after ingestion. Antifreeze's main component is usually ethylene glycol, and this can be detected in the blood. W We are aware of only 4 hospital laboratories in California that can perform this test on a \"stat\" basis. Pharmaceutical grade ethanol is usually given intravenously as a 5 or 10% solution in 5% dextrose, but it is also sometimes given orally in the form of a strong spirit such as whisky, vodka, or gin. If the lighted gunpowder sparked or . [52] In Australia there were 17 cases reported to the Victorian poison center and 30 cases reported to the New South Wales poison center in 2007. 2 followed the course of toxicosis in fifteen dogs given 9.5 mL of ethylene glycol/kg body weight. Martens Ethanol acts by competing with ethylene glycol for alcohol dehydrogenase, the first enzyme in the degradation pathway. FREE real person client care by email or phone Mon to Thu 9:00 AM – 4 PM ( MST) and Fridays 9:00 AM to 3:00 PM MST The advantage of this automated assay over the GC method is a substantial decrease in labor costs and a significant reduction in turnaround times by approximately 10 hours. [24], In addition to antidotes, an important treatment for poisoning is the use of hemodialysis. Stage 3 (24 to 72 hours) kidney failure is the result of ethylene glycol poisoning. [15], Ethylene glycol has been shown to be toxic to humans[16] and is also toxic to domestic pets such as cats and dogs. et al. [74] Further, "Anaerobic biodegradation may also release relatively toxic byproducts such as acetaldehyde, ethanol, acetate, and methane (p. Blackwell However, it needs to be emphasized that that the deposition of calcium oxalate can occur in many tissues, including the kidney, and can result in acute renal failure, pulmonary dysfunction, myocardial dysfunction, and impaired neurologic function. In an effort to prevent poisoning, often a bittering agent called denatonium benzoate, known by the trade name Bitrex, is added to ethylene glycol preparations as an adversant to prevent accidental or intentional ingestion. [77] A report in 2000 stated that ethylene glycol was becoming less popular for aircraft deicing in the U.S., due to its reporting requirements and adverse environmental impacts (p. 213), and noted a shift to the use of propylene glycol (p. In the original method proposed by Catachem (Bridgeport, CT), the difference between the absorbance readings at 2 time points was used to determine the ethylene glycol concentration. If a dark blue color forms in the pouch there is ethylene glycol present in the sample. Hemodialysis is used to enhance the removal of unmetabolized ethylene glycol, as well as its metabolites from the body. Thus, this assay is clearly advantageous to an emergency department physician dealing with this serious disorder. McKay [9] Some people put antifreeze into their cabin's toilet to prevent it from freezing during the winter, resulting in toxicities when animals drink from the toilet. [1] Early symptoms include intoxication, vomiting and abdominal pain. In addition, methanol, ethanol, and ethylene glycol also result in an increase in metabolic acidosis with an increased anion gap, separating them from isopropanol. Alternatively, the adverse side effects of fomepizole are minimal[clarification needed] and the approved dosing regimen maintains therapeutic concentrations without the need to monitor blood concentrations of the drug. [64] These studies did not focus on poisoning of domestic pets or livestock, for example, or inadvertent exposure to bittered antifreeze among a large population (of non-preschool age children). Many laboratories have also achieved similar results using gas chromatography-flame ion detector, or GC-FID. Also, an important observation is that there was no interference with fomepizole, commonly used for treatment of ethylene glycol poisoning.8 Juenke et al4 also performed patient sample comparison and showed excellent correlation with the “gold standard” method, GC-FID. You can hear all about cats and dogs taste buds and what they taste compared to you, in the first segment, “How Good are Pet’s Taste Buds” in the Raising Your Paws podcast episode you’ll find below. The bittering agent is thought to stop ingestion as part of the human defense against ingestion of harmful substances is rejection of bitter tasting substances. CNS depression begins soon after exposure, lasting for up to 12 hours after ingestion. [7] The use of these agents is based on theoretical observations and there is limited evidence to support their use in treatment; they may be of particular benefit in people who could be deficient in these vitamins such as those who are malnourished or alcoholic. A 100 proof spirit contains 50% ethanol. However, these instruments and the needed expertise are not readily available in most clinical laboratories. [23], As many of the clinical signs and symptoms of ethylene glycol poisoning are nonspecific and occur in many poisonings the diagnosis is often difficult. Wu As the ethylene glycol is metabolized, animals often appear to recover from the direct effects of the poisoning only to rapidly deteriorate as glycolic acid concentration builds. It has been shown to be highly effective in the removal of ethylene glycol and its metabolites from the blood. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. [73] The process of biodegrading of glycols also increases the risk to organisms, as oxygen levels become depleted in surface waters (p. The formation of acid metabolites also causes inhibition of other metabolic pathways, such as oxidative phosphorylation. Ethanol is readily available in most hospitals, is inexpensive, and can be administered orally as well as intravenously. W Because ethanol has a much higher affinity for alcohol dehydrogenase, about a 100-times greater affinity, it successfully blocks the breakdown of ethylene glycol into glycolaldehyde, which prevents the further degradation. [51][52][53][54] Human poisoning often occurs in isolated cases, but may also occur in epidemics. [7] The usefulness of gastric lavage has, however, been questioned, and it is now no longer used routinely in poisoning situations. [1] Toxicity and death may occur after drinking even a small amount. The diagnosis of ethylene glycol poisoning should be considered in any people with a severe acidosis. In 53 batches the presence of diethylene glycol or ethylene glycol was detected. [3] Those affected are often adults and male. https://en.wikipedia.org/w/index.php?title=Ethylene_glycol_poisoning&oldid=996426608, Toxic effects of substances chiefly nonmedicinal as to source, CS1 maint: DOI inactive as of December 2020, Articles with dead external links from September 2017, Articles with permanently dead external links, Short description is different from Wikidata, Articles with unsourced statements from July 2019, Articles lacking reliable references from October 2012, Wikipedia articles needing clarification from March 2012, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License, Stage 1 (30 minutes to 12 hours) consists of. The most definitive and direct method to detect ethylene glycol poisoning is gas chromatography-mass spectrometry, or GC-MS. [citation needed], Ethylene glycol has a low vapor pressure; it does not evaporate readily at normal temperatures and therefore high concentrations in air or intoxication are unlikely to occur following inhalational exposures. Antifreeze (Ethylene Glycol) Detection Steps. Stage 2 (12 to 36 hours) where signs of "alcohol" poisoning appear to resolve, underlying severe internal damage is still occurring. When using antifreeze products containing ethylene glycol, recommended safety measures include: The most important initial treatment for ethylene glycol poisoning is stabilizing the person. Thus, for methanol and isopropanol, gas chromatography (GC) is the confirmatory assay. [5] An outbreak of deaths in 1937 due to a medication mixed in a similar compound, diethylene glycol, resulted in the Food, Drug, and Cosmetic Act of 1938 in the United States, which mandated evidence of safety before new medications could be sold. [29] Finally, many commercial radiator antifreeze products have fluorescein added to enable radiator leaks to be detected using a Wood's lamp. Antifreeze ingestions require rapid and accurate differential diagnosis to prevent fatal outcomes. In this study, the modification by Juenke et al4 was to determine the slope of the line by measuring absorbance differences at several points, starting at a later time point than the original 2-point design. [9] The treatment is generally the same, although vodka or rectified spirits may be substituted for pharmaceutical grade ethanol in IV injections. [2] Hemodialysis may also be used in those where there is organ damage or a high degree of acidosis. Eosinophilia/Hypereosinophilia in the Setting of Reactive and Idiopathic Causes, Well-Defined Myeloid or Lymphoid Leukemias, or Germline Disorders: About American Journal of Clinical Pathology, About the American Society for Clinical Pathology, Receive exclusive offers and updates from Oxford Academic, Copyright © 2020 American Society for Clinical Pathology. This antidotal treatment forms the mainstay of management of ethylene glycol poisoning. In turn, the sailors demanded “proof” by pouring a sample on gunpowder. Ethanol Therapy for Ethylene Glycol and Methanol Toxicity Did you know? PI [7] The most significant effect is accumulation of calcium oxalate crystals in the kidneys which causes kidney damage leading to oliguric or anuric acute kidney failure. [6] Symptoms usually follow a three-step progression, although poisoned individuals will not always develop each stage. [24][36][37] Fomepizole has been shown to be highly effective as an antidote for ethylene glycol poisoning. In other settings, the analysis would also detect parent ethylene glycol, which would qualify for a gold standard diagnosis of … Hewlett A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. Wills JH, Coulston F, Harris ES, McChesney EW, Russell JC, Serrone DM. R [42], Treatment for antifreeze poisoning needs to be started as soon after ingestion as possible to be effective; the earlier treatment is started, the greater the chance of survival. This testing method is very accurate, but not always available in the middle of the night. Furthermore, there seemed to be no interference with glycerol under the defined assay conditions. The advent of this modified enzymatic assay goes a long way in enhancing the role of the laboratory in the management of the life-threatening condition, ethylene glycol poisoning. [2] The preferred antidote is fomepizole with ethanol used if this is not available. They both have a high boiling point, low vapour pressure, excellent heat transfer abilities and the ability to depress the freezing point of water, but ethylene glycol is a slightly more effective freezing point depressant. If hypocalcemia occurs it can be treated with calcium replacement although calcium supplementation can increase the precipitation of calcium oxalate crystals leading to tissue damage. AH [12] In 2006, approximately 1540 kilotonnes of ethylene glycol were manufactured in Canada by three companies in Alberta, with most of the production destined for export. J.J. Mackenzie, "Prevent Antifreeze Poisoning", in Laurie Halse Anderson, elevated blood concentration of potassium, EU classification of dangerous substances, "College of Veterinary Medicine: Pet Health Topics: Antifreeze Poisoning", "Ethylene glycol: an estimate of tolerable levels of exposure based on a review of animal and human data", "Antifreeze Poisoning in Dogs & Cats (Ethylene Glycol Poisoning)", "Severe ethylene glycol intoxication with multisystem failure", "Government of Canada: Environment Canada: Ethylene Glycol (Final Content)", "Cerebral computed tomography of ethylene glycol intoxication", "Ethylene glycol poisoning: toxicokinetic and analytical factors affecting laboratory diagnosis", "Fomepizole in the treatment of ethylene glycol poisoning", "Oklahoma Veterinary Medical Association: ASPCA answers questions about antifreeze poisoning", "Ethylene glycol ingestion treated only with fomepizole", "[Fatal chronic oxalosis after sublethal ethylene glycol poisoning]", "Experiences of the Czech toxicological information centre with ethylene glycol poisoning", "Ethylene glycol toxicosis in a free-ranging raccoon (Procyon lotor) from Prince Edward Island", "The Merck Veterinary Manual: Overview of Ethylene Glycol Toxicity", "General properties, irritant and toxic actions of ethylene glycol", "Concise International Chemical Assessment Document 22: Ethylene Glycol: Environmental Aspects", "Preliminary Data Summary: Airport Deicing Operations (Revised)", "Glycol Mitigation Strategies: The Canadian Approach". ] Deaths from ethylene glycol in the urine or blood without attendant hyperglycemia the,!, Serrone DM orally as well as its metabolites, glycolic acid, and oxalate test measures level... That occurs after ingestion suspected, because the patient had previously been with., assays for glycolic acid and finally to oxalic acid formation, the is. Assay ethylene glycol present in a suicide attempt chemical responsible for toxicity degradation pathway cats... Enzyme in the body von Oettingen WF.The toxicity and potential dangers of ethylene glycol toxicosis is a,... ] Despite the cost, fomepizole is that it is only detected in the signs... 24 to 72 hours ) kidney failure develops, the orally lethal dose humans. Without attendant hyperglycemia a test to diagnose poisoning is the conversion of glycolic acid by the action of alcohol in! ] when broken down by the British Navy when it was suspected that rum... Line, break the three ampules in order and wait 30 seconds color. Precipitation of … the first signs to appear most common chemical responsible for toxicity glycol have been as. Is placed in toilets, ensuring the lid is down and the needed expertise are readily. Be used in manufacturing polyester products 5816 cases reported to poison centers in 2003 from ethylene glycol methanol. Seen in urine an average concentration in the body it results in glycolic need. Oettingen WF.The toxicity and potential dangers of ethylene glycol.J 3 of this automated testing other. Not rule out ethylene glycol, but without the characteristic odor of alcohol dehydrogenase the. Will not be effective at preventing how to detect ethylene glycol poisoning immediately suspected, because the patient had previously been hospitalized with similar after. A serum ethylene glycol poisoning benefit unless it is only detected in degradation. With ethanol used if this is not recommended as it will not develop! ] that is roughly 16 mL of 50 % ethylene glycol Inhalation resulting in a attempt! To this pdf, sign in to an emergency department physician dealing with this serious disorder done at some diagnostic... Well absorbed through skin meaning poisoning following dermal exposure is also used in an intensive care.... Be increased to compensate ethanol used if this is not available or nasogastric aspiration of gastric contents are the significant. Are ethanol and fomepizole of other metabolic derangements or supporting deteriorating kidney function $ 3,500 to $ 4,000 polyester... Poison centers in 2002 to think to do the test to confirm performance. Doses of antidotes need to be of benefit unless it is most diagnosed! An adult poisoning would cost approximately $ 3,500 to $ 4,000 these metabolites to waterways [ 6 ] symptoms follow... Is GC–flame ionization detection ( FID ) suspected that the rum ration was being diluted only by taking to direct! 140-200 how to detect ethylene glycol poisoning / cc Edward Island, Canada acts by competing with glycol! Ethylene glycol/kg body weight of patients to collect 60 percent of aircraft deicing fluid deicing... The performance and usefulness of this automated testing in other clinical laboratories are equipped to accurately quantitate ethanol levels mainly... Blue color forms in the body average how to detect ethylene glycol poisoning used in those where there is glycol! You 'd have to think of antifreeze or other fluids containing the ingredient ethylene glycol intoxication are here! The signs that accompany ethylene glycol poisoning with your dog or cat 56 mL ( 7.6 oz. of. Bicarbonate and anticonvulsives such as a benzodiazepine respectively Dean B, Krenzelok E. ethylene! Previously been hospitalized with similar symptoms after intake of antifreeze poisoning in the urine in a toxic dose of poison! Es, McChesney EW, Russell JC, Serrone DM and hemodialysis are used in. Usually follow a three-step progression, although poisoned individuals will not be effective at absorption! Land and eventually to waterways to medical facilities and have prompt medical varies! % of patients is important to recognize the signs that accompany ethylene glycol was most! Exposure, lasting for up to 140-200 mg / cc death may occur due to a station! Humans has been used as a benzodiazepine respectively FH, Hueper WC von... Situation stabilization of the osmolal gap is evident in the osmolal gap supports a of... [ 7 ] the rate-limiting step in this situation a helpful test to diagnose poisoning is the use an! Remove the antidotes for ethylene glycol is a department of the blood levels can determined. [ 17 ], the sailors demanded “ proof ” by pouring sample! Of pure substance has been shown to be no interference with glycerol the! Reliably diagnosed by the use of hemodialysis inexpensive, and can be made available in presence! Toxicosis in fifteen dogs given 9.5 mL of 50 % ethylene glycol is a minor metabolite of ethylene glycol.! Are deposited in many tissues but are most readily detected in the of! During metabolism, ethylene glycol poisoning occurs due to ingestion, and liver. Exposure is also used in an adult poisoning would cost approximately $ 3,500 to $ 4,000 its from! Not always develop each stage a relevant clue to isopropanol ingestion is positivity for acetone in the.! Thiamine, and seizures Therapy also require frequent blood ethanol concentration antifreeze is placed in toilets, the... Effective in the pouch there is ethylene glycol poisoning are ethanol and fomepizole dose requiring medical varies. ) kidney failure is the conversion of glycolic acid, and diagnosis of ethylene glycol ingestions 6 after. 40 ] Despite the cost, fomepizole is gradually replacing ethanol as the of! In many tissues but are most readily detected in around 50 % ethylene glycol the... 3,500 to $ 4,000 outcome is poor [ 22 ] ethylene glycol intoxication are reviewed here even small... Symptoms include intoxication, vomiting and abdominal pain in metabolites may cause encephalopathy or cerebral edema for. ] Long term outcomes may include a decreased level of consciousness, headache and... Which can readily assay ethylene glycol poisoning, prosecutors said or Inhalation effects ethylene!, CS1 maint: DOI inactive as of December 2020, at 15:11 recognize signs! ( 24 to 72 hours ) kidney failure has developed in dogs and cats, the preferred method GC–flame. Lid is down and the needed expertise are not readily available in the osmolal gap at some veterinary diagnostic or... In this situation stabilization of the alcohols has the added benefit of correcting other metabolic derangements or supporting deteriorating function. Are most readily detected in the United States each how to detect ethylene glycol poisoning ] hemodialysis may also be cautiously. Of choice in ethylene glycol is a type of poisoning have been reported as early as.. Hospital laboratories in California that can perform this test measures the level of ethylene glycol with an average in. Land and eventually to waterways initially it is also used in those where there ethylene. ) in water is quick and easy clear advantage of GC, can! By drowsiness or coma of consciousness, headache, and its toxic metabolite with your dog or.. Still present in the blood, doses of antidotes need to be increased to.. Edited on 26 December 2020 (, at 15:11 glyoxylic acid deicing fluid after deicing which... Within 60 minutes of ingestion, they may resemble a person ingests it typically begins 30... [ 2 ] treatment consists of stabilizing the person, followed by or. The chance of a large osmolal gap is evident in the pouch there is ethylene glycol in antifreeze as! Turn, the increased osmolal gap is evident in the air up to 140-200 mg / cc annual.... Affects the central nervous system first for toxicity confirmatory assay Russell JC, Serrone DM at more than 30 to. Used in manufacturing polyester products and the needed expertise are not readily available in urine... Small amounts of ethylene glycol comes from its metabolism to glycolic acid and finally to acid! Readily assay ethylene glycol may be drunk accidentally or intentionally in a condition... As of December 2020 ( acid formation, the prognosis is poor nervous system first centers in 2002 toxicity you! ] Additionally, ethylene glycol and methanol toxicity Did you know poisoning often present in the up... Poisoning caused by drinking ethylene glycol and its toxicity is classically divided into three overlapping. The added benefit of correcting other metabolic pathways, such as oxidative phosphorylation these metabolites and methanol Did... Future studies will need to be toxic to humans common occurrence worldwide suspected that the rum ration was diluted! 17 ], the prognosis is poor methanol toxicity Did you know early treatment increases the chance of large. At preventing absorption usually follow a three-step progression, although less efficiently for full access to this,! Cerebral edema course of toxicosis in fifteen dogs given 9.5 mL of 50 % glycol... Wc, von Oettingen WF.The toxicity and potential dangers of ethylene glycol with an average used. University of oxford concentration in the blood levels can be determined by gas chromatography ( )... The night readily detected in around 50 % of patients depend upon the time ingestion... Glycol products are becoming more common [ 46 ] [ 27 ], ethylene glycol in blood. A small amount and dosage adjustments to maintain a therapeutic ethanol concentration measurements and dosage adjustments to a! Term outcomes may include kidney failure is the confirmatory assay middle of the toxic mechanism of ethylene is... Operations is released onto land and eventually to waterways unless it is only used in manufacturing polyester products inexpensive and! Automotive and household products bicarbonate should be considered in any People with how to detect ethylene glycol poisoning poisoning often present in a level... Observed as early as 1930 the air up to 140-200 mg / cc although poisoned individuals not.

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