Diethylene Glycol Poisoning

Diethylene glycol is an industrial solvent and is a major ingredient in antifreeze. Unfortunately, it is also a deadly poison, and it has caused over 300 deaths in the last year when counterfeiters substituted diethylene glycol for glycerin in cough syrups. Most of the deaths occurred in Panama, and an article in the New York Times recently traced the source of the poisonings to a manufacturer in China. From the NYT:

The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die.

The identification and treatment of ethylene glycol intoxication -- which presents identically to diethylene glycol poisoning -- is one of the classic poisonings taught to medical students. (Fortunately, most doctors never see it.) Patients appear intoxicated despite a normal blood alcohol level (unless alcohol was consumed at the same time). The blood is acidic, sometimes fatally so. Kidney failure is common. Dialysis, a way of cleaning the blood, is often used as a treatment for both kidney failure and to remove the poison and its byproducts.

Previously, intravenous infusions of ethyl alcohol were also used to treat ethylene glycol poisonings. The downsides were many, including difficulties with dosing and sedative effects. More recently, the medication fomepizole has taken the place of ethyl alcohol. With early treatment, most patients survive.

Lastly, diethylene glycol intoxication has historical importance -- it led to the creation of the Food and Drug Administration (FDA). In 1937, a preparation of Elixir Sulfanilamide used diethylene glycol as a solvent. (The manufacturer never tested it for toxicity.) 105 people died. This tragedy led directly to the passage of the 1938 Food, Drug and Cosmetic Act and the creation of the FDA.

For more information about diethylene glycol and ethylene glycol poisoning, see here.

Labels: diethylene_glycol, ethylene_glycol

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