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Acute Intoxications with Ethylene Glycol in Varna region: 25-Year Experience

Petko Marinov, Kaloyan Georgiev, Yulichka Subeva, Dobri Ivanov, Snezha Zlateva, Ivaylo Vazharov

Abstract

Ethylene glycol (EG) is a bivalent alcohol. It is composed of many commercial and industrial products such as anti-freeze, coolants, deicing fluids, brake solutions, detergents and lacquers and is used as an organic solvent of many substances. Accidental and intentional poisonings with EG are rare, but potentially lethal and are a challenge to the clinical toxicology. Retrospectively, we followed the acute intoxications with EG for a 25-year period (1991-2015) in the Varna region, Republic of Bulgaria. The subject of the study were 95 patients with acute EG poisoning, at an average age of 46.8 years (21-77), who had received treatment at the Clinic of Toxicology and the diagnosis was confirmed by gas chromatographic method. EG intoxications are specific to the male gender, at male:female ratio of 6.9:1. All poisonings resulted from oral intake, mainly of anti-freeze, 92.6% of them being accidental and only 7.4% - deliberate. A lethal outcome was registered in 8 (8.4%) patients. Extreme renal insufficiency occurred in 9 (10.3%) of the surviving patients.


Keywords

acute poisoning, intoxication, ethylene glycol, acute renal failure, hemodialysis, alcohol dehydrogenase, aldehyde dehydrogenase

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References

Buchanan JA, Alhelail M, Cetaruk EW, Schaeffer TH, Palmer RB, Kulig K, et al. Massive ethylene glycol ingestion treated with fomepizole alone - a viable therapeutic option. J Med Toxicol. 2010;6(2):131-4. doi: 10.1007/s13181-010-0061-2.

Marraffa J, Cohen V, Howland M. Antidotes for toxicological emergencies. Am J Health Syst Pharm. 2012;69(3):199-212. doi: 10.2146/ajhp110014.

Rietjens SJ, de Lange DW, Meulenbelt J. Ethylene glycol or methanol intoxication: which antidote should be used, fomepizole or ethanol? Neth J Med. 2014;72(2):73-9.

Nagesh IV, Koley KC, Sen S, Mohan S, Sahu S. Ethylene glycol poisoning. Med J Armed Forces India. 2015;71(1):36-8. doi: 10.1016/j.mjafi.2013.01.010.

Viinamaki J, Sajantila A, Ojanpera I. Ethylene glycol and metabolite concentrations in fatal ethylene glycol poisonings. J Anal Toxicol. 2015; 39(6):481-5. doi: 10.1093/jat/bkv044.

Leth P, Gregersen M. Ethylene glycol poisoning. Forensic Sci Int. 2005;155(2-3):179-84. doi: 10.1016/j.forsciint.2004.11.012.

Schwerk N, Desel H, Schulz M, Schwerk C, Kiess W, Siekmeyer W. Successful therapy of paediatric ethylene glycol poisoning: a case report and annual survey by a regional poison centre. Acta Paediatr. 2007;96(3):461-3. doi: 10.1111/j.1651-2227.2007.00115.x.

Kruse JA. Methanol and ethylene glycol intoxication. Crit Care Clin. 2012;28(4):661-711. doi: 10.1016/j.ccc.2012.07.002.

McMartin K, Jakobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016;81(3):505-15. doi: 10.1111/bcp.12824.

Green R. The management of severe toxic alcohol ingestions at a tertiary care center after the introduction of fomepizole. Am J Emerg Med. 2007;25(7):799-803. doi: 10.1016/j.ajem.2007.01.017.

Rooney SL, Ehlers A, Morris C, Drees D, Davis SR, Kulhavy J, et al. Use of a rapid ethylene glycol assay: a 4-year retrospective study an academic medical center. J Med Toxicol. 2016;12(2):172-9. doi: 10.1007/s13181-015-0516-6.

Brent J. Fomepizole for the treatment of pediatric ethylene and diethylene glycol, butoxyethanol and methanol poisonings. Clin Toxicol (Phila). 2010;48(5):401-6. doi: 10.3109/15563650.2010.495347.

Seo JW, Lee JH, Son IS, Kim YJ, Kim do Y, Hwang Y, et al. Acute oxalate nephropathy caused by ethylene glycol poisoning. Kidney Res Clin Pract. 2012;31(4):249-52. doi: 10.1016/j.krcp.2012.09.007.

Ting SM, Ching I, Nair H, Langman G, Suresh V, Temple RM. Early and late presentations of ethylene glycol poisoning. Am J Kidney Dis. 2009;53(6):1091-7. doi: 10.1053/j.ajkd.2008.12.019.

McMatrin K. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? Clin Toxicol (Phila). 2009;47(9):859-69. doi: 10.3109/15563650903344793.

Tanasescu A, Macovei RA, Tudosie MS. Outcome of patients in acute poisoning with ethylene glycol - factors which may have influence on evolution. J Med Life. 2014;7 Spec No 3):81-6.

Maekawa N, Hoshiyama E, Suzuki K, Ono K. Brain magnetic resonance image changes following acute ethylene glycol poisoning. Neurol India. 2015;63(6):998-1000.

Guo C, Cenac TA, Ly Y, McMartin K. Calcium oxalate and not other metabolites is responsible for the renal toxicity of ethylene glycol. Toxicol Lett. 2007;173(1):8-16.

Druteika D, Zed PJ, Enson MH. Role of fomepizole in the management of ethylene glycol toxicity. Pharmacotherapy. 2002;22(3):365-72.

Lung DD, Kearney TE, Brasiel JA, Olson KR. Predictors of death and prolonged renal insufficiency in ethylene glycol poisoning. J Intensive Care Med. 2015;30(5):210-7. doi: 10.1177/0885066613516594.

Gzyewska S, Winnicka R, Rzepecki J, Kolacinski Z, Politanski P, Sawicka J, et al. Acute ethylene glycol poisoning among patients of Nofer Institute of Occupatienal Medicine in Lodz, Toxicology Unit, hospitalized in the years 2000-2009. Przegl Lek. 2013;70(8):500-5 (in Polish).

Thanacoody RH, Gilfillan C, Bradberry SM, Davies J, Jackson G, Vale AJ, et al. Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS). Clin Toxicol (Phila). 2016;54(2):134-40. doi: 10.3109/15563650.2015.1116044.

Kraut JA. Diagnosis of toxic alcohols: limitations of present methods. Clin Toxicol (Phila). 2015;53(7):589-95. doi: 10.3109/15563650.2015.1056880.

Geibprasert S, Gallucci M, Krings T. Alcohol-induced changes in the brain as assessed by MRI and CT. Eur Radiol. 2010;20:1492-501. doi: 10.1007/s00330-009-1668-z.

Hegde AN, Mohan S, Lath N, Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31(1):5-30. doi: 10.1148/rg.311105041.

Montjoy CA, Rahman A, Teba L. Ethylene glycol and methanol poisonings: case series and review. W V Med J. 2010;106(6):17-23.

Ghannoum M, Hoffman RS, Mowry JB, Lavergne V. Trends in toxic alcohol exposures in the United States from 2000 to 2013: a focus on the use of antidotes and extracorporeal treatments. Semin Dial. 2014;27(4):395-401. doi: 10.1111/sdi.12237.

Ghannoum M, Lavergne V, Gosselin S, Mowry JB, Hoegberg LC, Yarema M, et al. Practice trends in the use of extracorporeal treatments for poisoning in four countries. Semin Dial. 2016;29(1):71-80. doi: 10.1111/sdi.12448.

Rogaczewska A, Kobza-Sindlewska K, Krakowiak A, Piekarska-Wijatkowska A. Acute alcohol poisoning among patients in Toxicology Unit, Nofer Insitute of Occupational Medicine in the period of time 2007-2012. Przegl Lek. 2014;71(9):479-83 (in Polish).

Coulter CV, Farquhar SE, McSherry CM, Isbister GK, Duffull SB. Methanol and ethylene glycol acute poisoning - predictors of mortality. Clin Toxicol (Phila). 2011;49(10): 900-6. doi: 10.3109/15563650.2011.630320.

Swiderska A, Sein Anand J. Selected data of acute poisonings with ethylene glycol and methanol in Poland in the year 2010. Przegl Lek. 2013;70(8):479-84 (in Polish).




DOI: http://dx.doi.org/10.14748/ssm.v49i3.4015

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About The Authors

Petko Marinov
MU-Varna
Bulgaria

Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Paraskev Stoianov”- Varna, Marin Drinov Str.55, 9002 Varna, Bulgaria

Kaloyan Georgiev
MU-Varna
Bulgaria

Department of Pharmaceutical technologies, Faculty of Pharmacy, Medical University “Prof. Paraskev Stoianov”- Varna, Marin Drinov Str.55, 9002 Varna, Bulgaria

Yulichka Subeva
MU-Varna
Bulgaria

Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Paraskev Stoianov”- Varna, Marin Drinov Str.55, 9002 Varna, Bulgaria

Dobri Ivanov
MU-Varna
Bulgaria

Department of Biology, Faculty of Pharmacy, Medical University “Prof. Paraskev Stoianov”- Varna, Marin Drinov Str.55, 9002 Varna, Bulgaria

Snezha Zlateva
MU-Varna
Bulgaria

Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Paraskev Stoianov”- Varna, Marin Drinov Str.55, 9002 Varna, Bulgaria

Ivaylo Vazharov

Bulgaria

Clinic of Internal Diseases, Naval Hospital – Varna, MilitaryMedical Academy, Bulgaria.

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