ISSN 2398-2969      

Ethylene glycol poisoning

icanis
Contributor(s):

Dawn Ruben

Larry Thompson

Synonym(s): Antifreeze poisoning


Introduction

  • One of the most common poisonings.
  • Highly palatable, drunk willingly, especially if no other water sources available.
  • Signs: vomiting, ataxia, polydipsia.
  • Treatment: ethanol, supportive fluid therapy, 4-methyl pyrazole.
  • Cause: antifreeze poisoning.
  • Diagnosis: signs, history, urinalysis, serum chemistry, commercial test kit.
  • Prognosis: guarded if delayed presentation.
    Follow the diagnostic tree for Evaluating Ataxia in Suspected Ethylene Glycol Toxicity Evaluating Ataxia in Suspected Ethylene Glycol Toxicity.

Pathogenesis

Etiology

  • Antifreeze consumed as concentrated solution. (undiluted = 95% ethylene glycol, working solution in car radiator is 50%).
  • Poisoning from drained radiator water.
  • Malicious poisoning.

Pathophysiology

  • Gastric irritant, metabolites are cytotoxic.
  • Absorption slowed by presence of food in gut.
  • Rapidly absorbed from GI tract and distributed in circulation.
  • Metabolized in liver.
  • Ethylene glycol → glycoaldehyde → glycolate → oxalate.
  • Excreted via kidneys.
  • Aldehydes cause central nervous system (CNS) toxicity.
  • Oxalate crystal formation → renal tubular damage.
  • Metabolites cytotoxic to renal tubular cells, also contribute to metabolic acidosis.
  • LD50 2-6 mg/kg (3-5 ml/kg).

Timecourse

  • Signs occur within 1 hour of ingestion, usually mild incoordination and ataxia. These resolve quickly.
  • Urinary excretion evident between 6-48 h.
  • 1-6 h CNS signs predominate.
  • 12-24 h cardiopulmonary signs appear.
  • 24-72 h oliguric renal failure.
  • Onset is quicker with greater ingestions.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Gaynor A R et al (1999) Acute Ethylene Glycol Intoxication. Part II. Diagnosis, Treatment, Prognosis and Prevention. Comp Contin Educ Pract Vet 21 (12), 1124-1133 VetMedResource.
  • Thrall M A et al (1998) Advances in therapy for antifreeze poisoning. Calif Vet 52, 18-22.
  • Murphy M J (1994) Toxin exposure in dogs and cats - drugs and household products. JAVMA 205 (4), 557-560 VetMedResource.
  • Crisp M S et al (1989) Peritoneal dialysis in dogs and cats - 27 cases (1976-1987). JAVMA 195 (9), 1262-1266 PubMed.

Organisation(s)

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