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CHAPTER 2-67: ETHYLENE GLYCOL AND OTHER GLYCOLS

Ilene B. Anderson

INTRODUCTION

Ethylene glycol is the primary ingredient (up to 95%) in antifreeze. It sometimes is consumed intentionally as an alcohol substitute by alcoholics and is tempting to children and pets because of its sweet taste. Intoxication by ethylene glycol itself causes inebriation and mild gastritis; more importantly, its metabolic products cause metabolic acidosis, renal failure, and death. Other glycols may also produce toxicity (Table II–26).

TABLE II–26.OTHER GLYCOLS
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TABLE II–26. OTHER GLYCOLS
Compounds Toxicity and Comments Treatment
Diethylene glycol (DEG) Highly nephrotoxic and neurotoxic. Epidemic poisonings have occurred when DEG has been inappropriately used in consumer products or as a diluent for water insoluble pharmaceuticals. Toxicity has also occurred after large acute ingestion and repeated dermal application in burn patients with extensive injuries. Clinical presentation includes initial ethanol-like inebriation and gastritis, metabolic acidosis, acute renal injury, dysphonia, cranial nerve VII paresis or paralysis, facial and peripheral extremity weakness, coma and death. Metabolic acidosis may be delayed for 12 hours or longer after ingestion. DEG is primarily metabolized to 2-hydroxyethoxyacetic acid and diglycolic acid. Diglycolic acid is likely responsible for the nephrotoxicity; however, DEG itself may also be toxic. Molecular weight is 106. Vd 1 L/kg (animal). Ethanol and fomepizole may limit toxicity due to DEG metabolites. Hemodialysis is indicated for patients with large ingestions, anuric renal failure or severe metabolic acidosis nonresponsive to medical treatments.
Dioxane (dimer of ethylene glycol) May cause coma, liver and kidney damage. The vapor (>300 ppm) may cause mucous membrane irritation. Dermal exposure to the liquid may have a defatting action. Metabolites unknown. Molecular weight is 88. Role of ethanol and fomepizole is unknown, but they may be effective.
Dipropylene glycol Relatively low toxicity. Central nervous system depression, hepatic injury, and renal damage have occurred in animal studies after massive exposures. There is a human report of acute renal failure, polyneuropathy, and myopathy after an ingestion of dipropylene glycol fog solution but no reports of acidosis or lactate elevation. Molecular weight is 134. Supportive care. There is no role for ethanol or fomepizole therapy.
Ethylene glycol monobutyl ether (EGBE, 2-butoxyethanol, butyl cellosolve) Clinical toxic effects include lethargy, coma, anion gap metabolic acidosis, hyperchloremia, elevated lactate, hypotension, respiratory depression, hemolysis, renal and hepatic dysfunction; rare disseminated intravascular coagulation (DIC), noncardiogenic pulmonary edema, and acute respiratory distress syndrome (ARDS). Oxalate crystal formation and osmolar gap elevation have been reported, but not in all cases. Serum levels in poisoning cases have ranged from 0.005 to 432 mg/L. Butoxyethanol is metabolized by alcohol dehydrogenase to butoxyaldehyde and butoxyacetic acid (BAA); however, the affinity of alcohol dehydrogenase for butoxyethanol is unknown. Molecular weight is 118. Ethanol, fomepizole, and hemodialysis may be effective.
Ethylene glycol monoethyl ether (EGEE, 2-ethoxyethanol, ethyl cellosolve) Calcium oxalate crystals have been reported in animals. Animal studies indicate that EGEE is metabolized in part to ethylene glycol; however, the affinity of alcohol dehydrogenase is ...

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