Ethylene glycol intoxication

• Alternative Names

  Intoxication - ethylene glycol; Ethylene glycol poisoning

• Causes, incidence, and risk factors

  Ethylene glycol may be swallowed accidentally, or it may be taken deliberately in a suicide attempt or as a substitute for drinking alcohol (ethanol).

• Symptoms

  The first symptom of ethylene glycol ingestion is similar to the feeling caused by drinking alcohol (ethanol). Within a few hours, more toxic effects become apparent. Symptoms may include nausea, vomiting, convulsions, stupor, or even coma.

  An overdose of ethylene glycol can damage the brain, lungs, liver, kidneys, and lungs. The poisoning causes disturbances in the body's chemistry, including metabolic acidosis. The disturbances may be severe enough to cause profound shock, organ failure, and death.

  As little as 120 milliliters (approximately 4 fluid ounces) of ethylene glycol may be enough to kill an average-sized man.

• Signs and tests

  Ethylene glycol toxicity should be suspected in anyone who is severely ill after drinking an unknown substance, especially if they at first appear drunk and do not have a smell of alcohol on their breath.

  Diagnosis of ethylene glycol toxicity is usually made through a combination of blood, urine, and other tests such as:

  • Arterial blood gas analysis
  • CHEM-7
  • Chest x-ray (shows fluids in the lungs)
  • Complete blood count (CBC)
  • CT scan (shows brain swelling)
  • EKG
  • Ethylene glycol test
  • Ketones - blood
  • Osmolality
  • Toxicology screen
  • Urinalysis

  Tests will show increased levels of ethylene glycol, blood chemical disturbances, and possible signs of kidney failure and muscle or liver damage.

• Treatment

  The goal of treatment is to support the body's vital functions and remove the poison from the body.

  Most people with ethylene glycol poisoning will need to be admitted to a hospital's intensive care unit (ICU) for close monitoring, and may need a breathing machine (respirator).

  Those who recently swallowed the ethylene glycol may have their stomach pumped (suctioned). This can help remove some of the poison.

  Other treatments may include:

  • Activated charcoal
  • Sodium bicarbonate solution given through a vein (IV) to reverse severe acidosis
  • Medicines that slow the formation of the poisonous by-products in the body

  In severe cases, hemodialysis may be used to directly remove the ethylene glycol and other poisonous substances from the blood. Dialysis reduces the time needed for the body to clear the toxins. Dialysis is also needed by patients who develop severe kidney failure as a result of ethylene glycol poisoning. It may be needed for many months afterwards.

• Expectations (prognosis)

  If treated promptly, patients with ethylene glycol poisoning can recover, even from renal failure or coma. However, with delayed or no treatment, ethylene glycol poisoning can be deadly.

• Complications
  • kidney failure
  • shock
  • coma
  • death
• Calling your health care provider

  Ethylene glycol ingestion is a medical emergency. If you suspect possible poisoning, seek emergency care immediately. Do not wait for poisoning symptoms to develop.

  You may also want to contact the National Poison Control Center at 1-800-222-1222. The center can be called from anywhere in the United States. The national hotline number will let you talk to experts in poisoning. They will give you further instructions.

  This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

  Take the container with you to the hospital, if possible.

  See: Poison control center - emergency number

• Prevention

  Keep substances that contain ethylene glycol out of the reach of children, and counsel persons who may abuse it.

• References

  Ford MD, Clinical Toxicology. 1st ed. Philadelphia, Pa: WB Saunders; 2001.

  Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006.

Review Date: 1/30/2009

Reviewed By: John E. Duldner, Jr., MD, MS, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Samaritan Regional Health System, Ashland, Ohio. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.