Ethylene glycol intoxication

Definition

Ethylene glycol is a colorless, odorless, sweet-tasting chemical found in many household products, including antifreeze, deicing products, detergents, paints, and cosmetics. It is poisonous if swallowed.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

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.