Three months after the ingestion, the patient presented with severe abdominal pain secondary to a colonic stricture and perforation, necessitating emergent colectomy. 1994 Mar-Apr. USA.gov. Reprod Toxicol. 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/. | Epub 2016 Sep 2. Ethylene glycol (C2H6O2) is a toxic alcohol that is found in various household and industrial agents. Max is a 3 year old, castrated male Pit Bull mix that presented to Iowa Veterinary Specialties due to loss of balance and coordination, walking in circles, and urinating while walking. J Med Toxicol. A Copper(II) Macrocycle Complex for Sensing Biologically Relevant Organic Anions in a Competitive Fluorescence Assay: Oxalate Sensor or Urate Sensor? Studies of the acute inhalation toxicity of ethylene glycol have not been published to date. Ethylene glycol exposure can be extremely dangerous, with significant morbidity and mortality if left untreated. 2018 Apr;13(3):375-383. doi: 10.1007/s11739-018-1799-9. Med., 1983, 141 (4), 473-480-A fatal case of poisoning by a mixture of methanol and ethylene glycol is described. Electrolyte Blood Press. Pomara C, Fiore C, D'Errico S, Riezzo I, Fineschi V. Clin Toxicol (Phila). The role of calcium oxalate crystal deposition in cerebral vessels during ethylene glycol poisoning. Histology of the resected colon revealed polarizable polyhedral crystals suggestive of oxalate deposition. An integrated perspective on the developmental toxicity of ethylene glycol. OVERVIEW >1 mL/kg or a mouthful in a child is potentially lethal 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 drunk: automotive antifreeze, solvent, polish, paints, cosmetics, brake fluid, car wash fluid. Since calcium oxalate monohydrate crystals are transported intracellularly by kidney cells, the renal toxicity of ethylene glycol may result from inhibition of mitochondrial respiratory function in proximal tubular cells by calcium oxalate monohydrate crystals. Epub 2005 Jan 21. It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. In my best Robert Duvall voice, “I love the smell of However, these crystals shouldn't be used to dictate major management decisions. It is most commonly encountered as automotive antifreeze.Diethylene glycol behaves similarly to ethylene glycol in an overdose. Montagnac R, Thouvenin M, Luxey G, Schendel A, Parent X. Nephrol Ther. Clin Toxicol (Phila). Fomepizole for the The previously reported gastrointestinal side effects of ethylene glycol toxicity are mostly nonspecific, including nausea, abdominal pain, and cramping. 2015 Oct;18(5):422-36. doi: 10.1089/rej.2014.1656. Toxic alcohol diagnosis and management: an emergency medicine review. Clin Toxicol (Phila). Severe ethylene glycol toxicity can cause profound morbidity and is almost universally fatal if untreated. Hontz D, Hensley J, Hiryak K, Lee J, Luchetta J, Torsiello M, Venditto M, Lucent D, Terzaghi W, Mencer D, Bommareddy A, VanWert AL. COVID-19 is an emerging, rapidly evolving situation. There is no visual disturbance. In animal studies, single oral Song CH, Bae HJ, Ham YR, Na KR, Lee KW, Choi DE. Initially it is metabolized by alcohol dehydro… Davis DP, Bramwell KJ, Hamilton RS, Williams SR. J Emerg Med. We recommend their use if the ethylene glycol level is >3.2 mmol/L (20 mg/dL), or if the patient has an osmolar gap >10 mOsm/L and serum bicarbonate <20 mEq/L, pH <7.3, or oxalate crystals in urine. Ethylene glycol is not volatile, and risk of inhalation exposure is minimal. 1999 Jun;26(3):295-300, 335; quiz 301-2. 1997 Sep-Oct;15(5):653-67. doi: 10.1016/s0736-4679(97)00145-5. 5.2.2 Ethylene Glycol-Induced Oxidative Stress and Toxicity Ethylene glycol is found in automobile antifreeze (major use) and hydraulic brake fluid. polyethylene glycol It is only the most common toxin among a whole family of glycols: -Dioxane- the dimer of ethylene glycol - which causes coma and hepatic / renal failure A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2) Vitamins: Despite the lack of clinical evidence for benefit, there is little risk to administering either of these vitamin cofactors in ethylene glycol metabolism. 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/, NLM USA.gov. 3.1.2 Environmental Effects The critical toxicity values presented in the SoS Report (Environment Canada and Health Canada 2000), namely the IC 25 of 3268 mg/L for the green alga Selenastrum capricornutum and the subchronic toxicity value of 4732 mg/L for the amphibian Xenopus laevis, still represent the most sensitive measurements of toxicity of ethylene glycol to aquatic organisms. 2005 Dec 15;353(24):e21. Fomepizole is a … Ethylene glycol poisoning should be suspected in an intoxicated patient with anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol concentration. The previously reported gastrointestinal side effects of ethylene glycol toxicity are mostly nonspecific, including nausea, abdominal pain, and cramping. | 2017 Dec;15(2):47-51. doi: 10.5049/EBP.2017.15.2.47. This damage can be identified in a serum biochemistry profile by increases in the levels of creatinine and BUN (blood urea nitrogen) that are normally removed from the blood by the kidneys. Epub 2018 Feb 9. Calcium oxalate crystals in the urine should prompt consideration of ethylene glycol toxicity. Buchanan JA, Alhelail M, Cetaruk EW, et al. Calcium oxalate crystals in acute ethylene glycol poisoning: a confocal laser scanning microscope study in a fatal case. 2. Urinary Calcium Oxalate Crystals in Ethylene Glycol Intoxication List of authors. Ethylene glycol (IUPAC name: ethane-1,2-diol) is an organic compound with the formula (CH2OH)2. Epub 2017 Dec 31. Max has no prior history of seizures to the owners’ knowledge, but they have owned him for only three months. A Case of Poisoning by a Mixture of Methanol and Ethylene Glycol. NIH Tohoku J. exp. Calcium oxalate crystals in acute ethylene glycol poisoning: a confocal laser scanning microscope study in a fatal case. Epub 2014 Aug 13. 2008 Apr;46(4):322-4. doi: 10.1080/15563650701419011. 2017 Dec;15(2):47-51. doi: 10.5049/EBP.2017.15.2.47. | The presence of calcium oxalate or hippurate crystals in the urine, together with an elevated anion gap or osmolal gap, strongly suggests ethylene glycol poisoning (Albertson 1999). 2020 Jul 27;5(31):19469-19477. doi: 10.1021/acsomega.0c01655. Ng PCY, Long BJ, Davis WT, Sessions DJ, Koyfman A. Intern Emerg Med. but he is free to roam three acres … [Crystalluria in ethylene glycol intoxication]. These 95% commercial antifreeze preparations are diluted ~50% with water when used in vehicle cooling systems. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. Many veterinarians are familiar with ethylene glycol toxicity because of the frequent cases in … The published LD 50 values and symptoms of toxicity after oral administration are summarized in Table 1. Jose Morfin, M.D., and Andrew Chin, M.D. Urinary calcium oxalate crystals in ethylene glycol intoxication. 2005 Dec 20;155(2-3):179-84. doi: 10.1016/j.forsciint.2004.11.012. HHS Urolithiasis. Initial symptoms of ethylene glycol intoxication (0.5 to 12 hours after ingestion) are due to the direct toxicity of ethylene glycol. ANNA J. Electrolyte Blood Press. Ethylene glycol toxicity is complex and not fully understood, but is mainly due to the severe metabolic acidosis caused by … The central nervous system is affected early in the course of poisoning as the result of a direct action of ethylene glycol. | Clin Exp Nephrol. • The metabolites of EG are responsible for most of the systemic toxicity. Glycolate is metabolised by various pathways, including one to oxalate which rapidly precipitates with calcium in various tissues and in the urine. 2014 Nov;10(6):475-7. doi: 10.1016/j.nephro.2014.04.003. 2010 Jun;6(2):131-4 full-text Boyer EW, Mejia M, Woolf A, Shannon M. Severe ethylene glycol ingestion treated without hemodialysis. All animals are susceptible to ethylene glycol (EG) toxicity, but it is most common in dogs and cats. Most intoxications are associated with ingestion of antifreeze, which is typically 95% EG. Epub 2015 Sep 22. 2006;44(3):315-8. doi: 10.1080/15563650600588460. In addition, hepatic damage due to calcium oxalate deposition has been A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy. Author information: (1)Johns Hopkins University, Baltimore, MD mhanoun1@jhmi.edu. Ethylene glycol (C2H6O2 Ethylene glycol is an odorless, colorless, sweet-tasting syrupy substance with a molecular weight of 62.07, freezing point of -13°C and a boiling point of 197.6°C. 2017 Aug;21(4):741-742. doi: 10.1007/s10157-016-1332-2. All animals are susceptible to ethylene glycol (EG) toxicity, but it is most common in dogs and cats. HHS 2020 Oct;48(5):377-384. doi: 10.1007/s00240-020-01202-w. Epub 2020 Jul 27. NIH Ethylene glycol tastes sweet, which is why some animals are attracted to it. He has also been trembling. Clipboard, Search History, and several other advanced features are temporarily unavailable. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. COVID-19 is an emerging, rapidly evolving situation. Central nervous system depression with intoxication, pulmonary edema, and acute oliguric renal failure with crystalluria are among the most commonly encountered complications of ingestion. PMID: 29020580 [Indexed for MEDLINE] MeSH terms 2008 Apr;46(4):322-4. doi: 10.1080/15563650701419011. | Massive ethylene glycol ingestion treated with fomepizole alone-a viable therapeutic option. Forensic Sci Int. 2009 Nov;47(9):859-69. doi: 10.3109/15563650903344793. A major commercial application of ethylene glycol is deicing fluid for aircrafts. Ethylene glycol poisoning: case report of a record-high level and a review. Urinary Crystals. Ethylene glycol is a precursor for many polymers, eg. Ethylene glycol is a widely used and readily available substance. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? A 72-year-old man was hospitalized when he was found stuporous to semicomatose, and despite massive bicarbonate therapy, died 36 hr after the admission. Seizures may occur due to a direct effect. Ethylene glycol exposure can lead to the development of renal failure due to the metabolic formation of calcium oxalate monohydrate (COM) crystals. Overview of Ethylene Glycol Toxicity. However, ethylene glycol itself is relatively non-toxic; its metabolites are highly toxic causing renal failure secondary to calcium oxalate precipitate within the renal tubules and metabolic acidosis due to glycolic acid circulation Brent, 2009). Pomara C, Fiore C, D'Errico S, Riezzo I, Fineschi V. Clin Toxicol (Phila). • Decreased mentation and an elevated osmolal gap are two of the earlier findings seen after exposure. Cryoprotectant Toxicity: Facts, Issues, and Questions. Urinary crystals result from. the precipitation of calcium by the oxalic acid metabolite of ethylene glycol. Please enable it to take advantage of the complete set of features! Ethylene glycol is converted by the liver into toxic byproducts that are damaging to the kidneys. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Ethylene glycol is a colorless and odorless dihydroxyl alcohol with a myriad of uses, most commonly found in antifreeze. Calcium oxalate monohydrate crystals in ethylene glycol poisoning. CNS effects predominate and include inebriation (without the alcohol odor on the breath), slurred speech, drowsiness, somnolence, hypotonia, hyporeflexia, ataxia, myoclonic jerks, and gastrointestinal upset. ACS Omega. CNS depression begins soon after exposure, lasting for up to 12 hours after ingestion. This depression appears similar to ethanol intoxication, but without the characteristic odor of alcohol. We describe a patient who developed acute colonic ischemia following ethylene glycol intoxication. Please enable it to take advantage of the complete set of features! 8(2):99-113. . NLM Images in clinical medicine. Song CH, Bae HJ, Ham YR, Na KR, Lee KW, Choi DE. Ethylene glycol intoxication: pathophysiology, diagnosis, and emergency management. Similar to ethanol, it causes intoxication, followed by drowsiness or coma. Hanouneh M(1), Chen TK(1). Related Articles A 73 … Calcium oxalate crystal deposition in the kidney: identification, causes and consequences. In addition, hepatic damage due to calcium oxalate deposition has been reported. • Ethylene glycol (EG) is a relatively common and potentially fatal intoxicant in small animals. There is no known exposure to drugs, medications, toxins, compost, garbage, etc. Calcium Oxalate Crystals in Ethylene Glycol Toxicity. | mitochondrial permeability transition, ethylene glycol poisoning, renal toxicity, oxalate crystals Ethylene glycol poisoning in humans and animals is characterized by a severe metabolic acidosis, cardiopulmonary complications, acute renal failure, … PDF | On Feb 1, 1966, Kevin E. Bove published Ethylene Glycol Toxicity | Find, read and cite all the research you need on ResearchGate This site needs JavaScript to work properly. Epub 2017 Dec 31. eCollection 2020 Aug 11. N Engl J Med. Features suggestive of ethylene glycol toxicity are HAGMA, high osmolar gap and oxalate crystals in urine. doi: 10.1056/NEJMicm050183. The three main systems affected by ethylene glycol poisoning are the central nervous system, metabolic processes, and the kidneys. Most intoxications are associated with ingestion of antifreeze, which is typically 95% EG. N Engl J Med 377; 15 Oct 12, 2017 アルコール依存症の80歳男性。 意識障害で転倒したため来院した。 血液検査でCr 2.4mg/dL, AG 26mmol/L, 血漿浸透圧 357mOsm/kgH20, 浸透圧ギャップ 49mOsm/kgH20であった。 尿 It is an odorless, colorless, sweet-tasting, viscous liquid. This site needs JavaScript to work properly. Rejuvenation Res. Brent J, McMartin K, Phillips S, Burkhart KK, Donovan JW, Wells M, et al. The pathophysiology underlying ethylene glycol intoxication, treatment strategies, and gastrointestinal toxicity are discussed. The toxic mechanism of ethylene glycol poisoning is mainly due to the metabolites of ethylene glycol. Carney EW. The renal damage is closely linked to the degree of COM accumulation in the kidney and most likely results from a COM-induced injury to proximal tubule (PT) cells. ) Macrocycle Complex for Sensing Biologically Relevant organic Anions in a fatal case, Burkhart KK Donovan. Glycol ingestion treated with fomepizole alone-a viable therapeutic option KJ, Hamilton RS Williams. 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Mhanoun1 @ jhmi.edu a fatal case of ethylene glycol is a toxic alcohol diagnosis and management: an medicine... To oxalate which rapidly precipitates with calcium in various tissues and in the kidney: identification, causes and.. High osmolar gap and oxalate crystals in ethylene glycol poisoning 27 ; 5 31! Severe abdominal pain, and emergency management glycol ingestion treated with fomepizole alone-a viable therapeutic option mechanism of Renal! In Table 1 several other advanced features are temporarily unavailable as the result a! Hepatic damage due to calcium oxalate deposition has been reported is a widely used and readily available substance ethylene glycol toxicity crystals. Volatile, and risk of inhalation exposure is minimal deposition has been.. 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