Ethylene glycol is a colorless, odorless, sweet-tasting chemical commonly used in
antifreeze and de-icing solutions. Its sweet taste can be attractive to children and animals, making accidental ingestion a significant risk. Ethylene glycol is also used in various industrial applications, such as the production of polyester fibers and as a solvent.
Poisoning typically occurs through accidental or intentional ingestion. Once ingested, ethylene glycol is metabolized in the liver by the enzyme
alcohol dehydrogenase into toxic metabolites, including glycolic acid and oxalic acid. These metabolites are responsible for the toxic effects on the body.
The symptoms of ethylene glycol poisoning can be divided into three stages. The initial stage, occurring within 30 minutes to 12 hours, includes neurological symptoms such as intoxication, dizziness, and confusion, which may resemble alcohol intoxication. The second stage, from 12 to 24 hours post-ingestion, involves cardiopulmonary symptoms like increased heart rate, high blood pressure, and respiratory distress. The final stage, occurring 24 to 72 hours after ingestion, can lead to severe metabolic acidosis, kidney failure, and, if untreated, death.
Early diagnosis is crucial for effective treatment. Diagnostic tests include measuring blood ethylene glycol levels and assessing metabolic acidosis through blood gas analysis. A high anion gap metabolic acidosis and elevated
osmolal gap are indicative of poisoning. Urinalysis may reveal calcium oxalate crystals, and imaging studies can assess renal damage.
The primary treatment for ethylene glycol poisoning involves inhibiting the metabolism of ethylene glycol into its toxic metabolites. This is achieved through the administration of
fomepizole or ethanol, both of which act as competitive inhibitors of alcohol dehydrogenase. Supportive care, including intravenous fluids and correction of acidosis with sodium bicarbonate, is also essential. In severe cases,
hemodialysis may be necessary to remove ethylene glycol and its metabolites from the bloodstream.
If treated promptly, patients can recover fully from ethylene glycol poisoning. However, delayed treatment may lead to long-term complications such as chronic kidney damage, neurological deficits, or even death. Hence, timely medical intervention is critical.
Prevention strategies include using products containing ethylene glycol in areas inaccessible to children and pets, ensuring proper labeling and storage of such substances, and considering the use of
propylene glycol-based antifreeze, which is less toxic. Public education about the dangers of ethylene glycol and safer alternatives can also help reduce the incidence of poisoning.
Conclusion
Ethylene glycol poisoning is a serious medical condition that requires immediate attention. Understanding the
pathophysiology, symptoms, diagnostic methods, and treatment options is essential for healthcare professionals and the general public. Through proper preventive measures and timely medical intervention, the risks associated with ethylene glycol poisoning can be significantly minimized.
