Ethylene Glycol and Propylene Glycol Toxicity
How Should Patients Exposed to Ethylene Glycol Be Evaluated?
Course: WB 1103
CE Original Date: October 3, 2007
CE Renewal Date: October 3, 2010
CE Expiration Date: October 3, 2012
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Learning Objectives |
Upon completion of this section, you should be able to describe
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Introduction |
Ethylene glycol ingestion is a medical emergency requiring prompt recognition and aggressive treatment.
Therefore, making a correct diagnosis requires a reliable history of the time, route, and magnitude of exposure. In some cases, however, a detailed history can be difficult to obtain because of the patient's altered mental state. If ethylene glycol poisoning is strongly suspected, begin appropriate treatment while waiting for confirmation by laboratory results (Stokes and Aueron 1980; Johnson, Meggs et al. 1999). Patients who have been exposed to ethylene glycol should undergo a thorough medical evaluation. Early and accurate diagnosis is important in deciding appropriate care strategies. In cases of ethylene glycol exposure, medical evaluation should include
This section focuses on the first three items, which are typically conducted during the patient's visit to your office. Recommended tests are discussed in the next section. |
Exposure History |
Although environmental exposures to ethylene glycol are a concern, nearly all cases of ethylene glycol poisoning are due to ingestions (Agency for Toxic Substances and Disease Registry 1997).
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Physical Examination |
The patient's vital signs should be monitored. Although not specific for ethylene glycol intoxication, the following symptoms have been associated with moderate or severe poisoning (Friedman, Greenberg et al. 1962; Parry and Wallach 1974):
A complete neurologic examination should be performed. Pay special attention to
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Clinical Presentation |
Patients who have ingested ethylene glycol often progress through three clinical stages (Friedman, Greenberg et al. 1962) (described earlier, Stages of Ethylene Glycol Intoxication) that represent a continuum. Individual patients may develop any combination of organ or systemic effects (Table 1). The time course for each stage, as well as the severity of illness, depends on the amount of ethylene glycol ingested and whether ethanol was ingested concurrently. Stage 1During the first 12 hours after ingestion, the following CNS effects predominate
Stage 2Stage 2 begins 12-24 hours after ingestion and is caused by the products of ethylene glycol metabolism. The primary manifestations are cardiopulmonary
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Stage 3Stage 3 occurs 24-72 hours after ingestion, if the condition is not treated. Acute renal dysfunction may occur, ranging from mild elevations in BUN and serum creatinine to oliguric renal failure.
In some cases, cranial nerve abnormalities may develop several days after exposure. These neurologic sequelae are usually found when treatment is delayed or inadequate. |
Key Points |
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Progress Check |
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