Ethylene glycol itself is a colourless fluid although the solutions it is commonly found in are often coloured in an attempt to prevent accidental ingestion. Stice, in reproductive and developmental toxicology second edition, 2017. Show this safety data sheet to the doctor in attendance. A rat study comparing some aspects of ethylene glycol and diethylene glycol toxicity showed that blood and kidney oxalate concentrations were higher when ethylene glycol was given 59. Human health aspects please note that the layout and pagination of this pdf file are not necessarily identical to the hard copy first draft prepared by r. However, it is generally only worthwhile if started within a few. We report a series of patients with ethylene glycol toxicity with a component of nonanion gap metabolic acidosis without known associated confounding factors.
Current management of ethylene glycol poisoning springerlink. Mar 28, 2017 ethylene glycol eg poisoning continues to be common. The chemical formula for ethylene glycol is c 2 h 6 o 2, and its molecular weight is 62. When an individual consumes ethylene glycol, it will be metabolized by the body in the similar way that it metabolizes ethyl alcohol.
Ethylene glycol ingestion is a medical emergency requiring prompt recognition and aggressive treatment. The actual clinical presentation changes over time as intoxication evolves. May 31, 2017 ethylene glycol is a colorless liquid that can be in the air in vapor form. How is ethanol used in the treatment of ethylene glycol toxicity. Challenges in the diagnosis of ethylene glycol poisoning. The toxicity of ethylene glycol can be divided into three phases. Diethylene glycol an overview sciencedirect topics. Ethylene glycol toxicity presenting with nonanion gap. Toxicity from this substance may be encountered in the military and civilian populations. System rfd mgkgday basis pod composite uf confidence. Background ethylene glycol poisoning causes metabolic acidosis and renal failure and may cause death.
Toxicity from this substance may be encountered in the military and. It can harm the eyes, skin, kidneys, and respiratory system. Ethylene glycol eg is an odorless, electrically neutral polyalcohol and a common solvent for antifreeze solutions, brake fluids, and household industrial products. Occur with the ingestion of at least 100 cc of ethylene glycol occur 618 days after the ingestion of ethylene glycol postmortem studies attribute this to inflammation around the nerve from oxalate microcrystal deposition. Propylene glycol, which is much less toxic than ethylene glycol, is metabolized to compounds that. Ethylene glycol occurs as a clear, slightly viscous liquid that is completely miscible with water. Pdf acute oral toxicity of ethylene glycol monomethyl ether. Acute oral toxicity of ethylene glycol monomethyl ether and diethylene glycol monomethyl ether. Ethylene glycol industrialethylene glycol meglobalglycolsolv ethylene glycol, section 4.
The comments and oehhas responses are posted with the notice of intent to list. Ethylene glycol, a sweettasting, odorless liquid, is the active ingredient in antifreeze. Signs and symptoms depend on the amount ingested and concurrent use of alcohol. Outcome of patients in acute poisoning with ethylene glycol. The pathogenesis of diethylene glycol toxicity was first believed to involve the in vivo formation of ethylene glycol as the result of metabolism. Nov 30, 2016 the pathogenesis of diethylene glycol toxicity was first believed to involve the in vivo formation of ethylene glycol as the result of metabolism. Fomepizole for the treatment of ethylene glycol poisoning nejm. Accordingly, the osmolal gap is frequently employed as a surrogate screening method in cases of suspected. Effective june 19, 2015, the office of environmental health hazard assessment oehha is adding ethylene glycol ingested cas no. After a characteristic latent period, signs of inebriation may be followed by serious illness, and even death, caused by toxic metabolites. Long term outcomes may include kidney failure and brain damage. Ethylene glycol ingestion results initially in cns effects.
Ethylene glycol is also used in the manufacture of detergents, paints, cosmetics, antifreeze and deicing products 2. Ethane1,2diol, monoethylene glycol meg, 1,2ethanediol, glycol. Download fulltext pdf acute and subchronic toxicity of ethylene glycol monobutyl ether article pdf available in environmental health perspectives 57. The standard treatment is inhibition of alcohol dehydrogenase with ethanol, given in intoxicati. Ethylene glycol and methanol are both readily absorbed from the gut e.
Ethylene glycol can also be found, in lower concentrations, in some windshield deicing agents, hydraulic brake fluid, motor oils, solvents, paints, film processing solutions, wood stains, inks, printer cartridges, etc. Ethylene glycol is a colorless liquid that can be in the air in vapor form. Later symptoms may include a decreased level of consciousness, headache, and seizures. The sweet taste, low cost, and intoxicating effects of eg lead to its illicit use as an ethanol substitute. Ethylene glycol eg poisoning is a toxicologic emergency requiring high clinical suspicion and early diagnosis to prevent lifethreatening complications. Based on these data it is be reasonable to conclude that the toxicity and treatment of ethylene glycol and diethylene glycol toxicity are similar, at least in. Ethylene glycol poisoning ethylene glycol poisoning is extremely serious in cats. Toxicity and death may occur after drinking even a. Cureus ethylene glycol toxicity in the setting of recurrent. Toxicity and death may occur after drinking even a small amount. Fomepizole for the treatment of ethylene glycol poisoning.
Ethylene glycol, a common antifreeze, coolant and industrial solvent, is responsible for many instances of accidental and intentional poisoning annually. Oral toxicity is expected to be moderate in humans due to ethylene glycol even though tests with animals show a lower degree of toxicity. An adult may drink ethylene glycol as a substitute for ethanol or in a suicide attempt. Ethylene glycol is a colorless and relatively nonvolatile liquid that has a high boiling point and a sweet taste, which is why children and pets tend to ingest it causing ethylene glycol toxicity. Following ingestion, ethylene glycol is first hepatically metabolised to glycoaldehyde by alcohol dehydrogenase. Ethylene glycol classically produces an elevated anion gap metabolic acidosis. The toxicology of glycol ethers and its relevance to man. Immediate treatment for eg toxicity is critical due to rapid progression and irreversibility of renal lesions, any patient suspected of consuming eg should be tested and decontaminated unlessuntil exposure has been ruled out.
Later, 1224 h after intoxication, a cardiorespiratory phase appears with onset of tachypnoea compensate for systemic acidosis, hypotension or. This iris assessment for ethylene glycol consists of hazard identification and doseresponse assessment data and provides support for epa risk management decisions. Pdf acute and subchronic toxicity of ethylene glycol. However, further animal studies showed that the major toxic metabolite is 2hydroxyethoxyacetic acid and that the metabolic conversion of diethylene glycol into ethylene glycol does not occur in vivo. Procedure for the presence of diethylene glycol and ethylene glycol in toothpaste. Glycoaldehyde is then oxidised to glycolic acid, glyoxylic acid and finally oxalic acid. Oct 03, 2007 ethylene glycol is a central nervous system cns depressant that can produce acute effects similar to those of ethanol. Methanol and ethylene glycol are frequently found in high concentration in automotive coolantantifreeze and deicing solutions, windshield wiper fluid, solvents, cleaners, fuels, and other industrial products. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. The standard treatment is inhibition of alcohol dehydrogenase with ethanol, given in. The toxicology of glycol ethers and its relevance to man ecetoc tr no. Ethylene glycol eg is a major industrial chemical used in the production of polyester fibers and films, antifreeze and vitrification formulations, and numerous other applications.
Epa has not classified the glycol ethers for carcinogenicity. Ethylene glycol concentration500mgl or presence of severe metabolic acidosis, renal failure, severe electrolyte imbalance, or generally deteriorating. Alcoholrelated intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. A complete, updated chemical list will be published in the california regulatory notice register and is available on the oehha website. Ethylene glycol can be recovered from the natural gas and reused as an inhibitor after purification treatment that removes water and inorganic salts. After a characteristic latent period, signs of inebriation may be followed by serious illness, and even death, caused by toxic metabolites propylene glycol, which is much less toxic than ethylene glycol, is metabolized to compounds that are normal constituents of the citric acid cycle no health effects have been reported in. Ethylene glycol is an inexpensive, readily available substance that may be associated with accidental or intentional toxicity. Ethylene glycol eg toxicity extended version rx of choice. How is 4methylpyrazole used in the treatment of ethylene glycol toxicity. These 95% commercial antifreeze preparations are diluted 50% with water when used in vehicle cooling systems. Ethylene glycol, also called 1,2ethanediol, is a viscous liquid with a sweet taste. Concise international chemical assessment document. Most intoxications are associated with ingestion of antifreeze, which is typically 95% eg.
Ethylene glycol industrial ethylene glycol meglobal glycol solv ethylene glycol, section 4. Ethylene glycol poisoning in dogs vca animal hospital. Direct eg quantification methods involve cumbersome and timeconsuming laboratory tests of limited utility in the emergency setting. If untreated, severe ethylene glycol toxicity is usually fatal within 24 to 36 hours. Removes ethylene glycol and glycolate effectively indications. Ethylene glycol eg poisoning continues to be common. The main toxicity results from hepatic metabolism of ethylene glycol to glycoaldehyde, glycolate, glyoxylate, and oxalate. Two cases are presented and the diagnosis and treatment of ethylene glycol toxicity are discussed. Outcome of patients in acute poisoning with ethylene. Propylene glycol rarely causes toxic effects, and then only under very unusual circumstances.
Loading dose is 15mgkg in 100 mls of ns or d5w infused over 30 minutes next 10mgkg every 12 hours for two days next 15mgkg every 12 hours until the ethylene glycol level is less than 2 and pt. The role of renal replacement therapy in the management of. Ethylene glycol has a halflife of 38 hours, whereas methanol has a halflife of 23 hours. Ethylene glycol toxicity military medicine oxford academic. Pdf acute oral toxicity of ethylene glycol monomethyl.
Acute non cancer health based value nhbv acute not derived insufficient data shortterm noncancer health based value. Ethylene glycol ethers national toxicology program. It is used to make antifreeze and deicing solutions for cars, airplanes, airport runways, and boats. Oct 03, 2007 ethylene glycol ingestion is a medical emergency requiring prompt recognition and aggressive treatment. Early symptoms include intoxication, vomiting and abdominal pain. Overview of ethylene glycol toxicity toxicology merck. Ethylene glycol in toothpaste using thermo scientific tracegold gc column with. Intoxication with ethylene glycol occurs as a result of intentional ingestion in suicide attempts or accidentally. Jan 23, 2017 ethylene glycol and methanol are both readily absorbed from the gut e. Because it is highly toxic and can result in death if not treated appropriately, it is imperative to recognize the signs and symptoms of intoxication. Gcms analysis of diethylene glycol and ethylene glycol in.
This article covers the metabolism of ethylene glycol, clinical signs of toxicity and establishing a diagnosis of eg poisoning, as well as the emergency management of patients with suspected or identified ingestion and the associated prognosis. In contrast to ethylene glycol, a potent cause of acute toxicity in humans, propylene glycol is a generally recognized as safe gras additive for foods and medications. Mechanism of toxicity, clinical course, diagnosis and treatment. This chapter describes the reproductive and developmental toxicity of eg. The main sources of information for this fact sheet are epas integrated risk information system iris 7, which contains information on inhalation chronic toxicity of 2methoxyethanol, 2ethoxyethanol, and 2. National toxicology program evaluated experiment interpreted results, and.
Ethylene glycol is used in hydraulic brake fluids and inks for stamp pads, ballpoint pens, and print shops. In cases of both accidental and purposeful ingestion, timely diagnosis of eg toxicity enables the administration. Workers may be harmed from exposure to ethylene glycol. Ethylene glycol is widely used to inhibit the formation of natural gas clathrates hydrates in long multiphase pipelines that convey natural gas from remote gas fields to a gas processing facility. Ethylene glycol can also be found, in lower concentrations, in some windshield deicing agents, hydraulic brake fluid, motor oils, solvents, paints, film processing solutions, wood. The effects of these substances, except for isopropanol and possibly. In summary, ethylene glycol is being listed under proposition 65 as known to the state to cause reproductive toxicity, as follows. All animals are susceptible to ethylene glycol eg toxicity, but it is most common in dogs and cats. The level of exposure depends upon the dose, duration, and work being done. As parent alcohol levels fall, acidic metabolites rise. These cns effects predominate during the first hours after exposure. The mortality rate of ethylene glycol intoxication ranges between 1 and 22% depending on the amount of alcohol ingestion and the time period between the alcohol ingestion and the initiation of therapy 1,2. Meek, health canada, ottawa, canada published under the joint sponsorship of the united nations environment programme, the.
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