[1][4] The diagnosis may be suspected when calcium oxalate crystals are seen in the urine or when acidosis or an increased osmol gap is present in the blood. At room temperature, ethylene oxide is a flammable colorless gas with a sweet odor. [7], The kidney toxicity of ethylene glycol occurs 24 to 72 hours post ingestion and is caused by a direct cytotoxic effect of glycolic acid. Epub 2018 Feb 9. [3] Those affected are often adults and male. It and its toxic byproducts first affect the central nervous system (CNS), then the heart, and finally the … Hemodialysis is usually indicated in people with severe metabolic acidosis (blood pH less than 7.3), kidney failure, severe electrolyte imbalance, or if the person's condition is deteriorating despite treatment. [12] In 2006, approximately 1540 kilotonnes of ethylene glycol were manufactured in Canada by three companies in Alberta, with most of the production destined for export. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. https://en.wikipedia.org/w/index.php?title=Ethylene_glycol_poisoning&oldid=996426608, Toxic effects of substances chiefly nonmedicinal as to source, CS1 maint: DOI inactive as of December 2020, Articles with dead external links from September 2017, Articles with permanently dead external links, Short description is different from Wikidata, Articles with unsourced statements from July 2019, Articles lacking reliable references from October 2012, Wikipedia articles needing clarification from March 2012, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License, Stage 1 (30 minutes to 12 hours) consists of. [37][38] It is the only antidote approved by the U.S. Food and Drug Administration for the treatment of ethylene glycol poisoning. J.J. Mackenzie, "Prevent Antifreeze Poisoning", in Laurie Halse Anderson, elevated blood concentration of potassium, EU classification of dangerous substances, "College of Veterinary Medicine: Pet Health Topics: Antifreeze Poisoning", "Ethylene glycol: an estimate of tolerable levels of exposure based on a review of animal and human data", "Antifreeze Poisoning in Dogs & Cats (Ethylene Glycol Poisoning)", "Severe ethylene glycol intoxication with multisystem failure", "Government of Canada: Environment Canada: Ethylene Glycol (Final Content)", "Cerebral computed tomography of ethylene glycol intoxication", "Ethylene glycol poisoning: toxicokinetic and analytical factors affecting laboratory diagnosis", "Fomepizole in the treatment of ethylene glycol poisoning", "Oklahoma Veterinary Medical Association: ASPCA answers questions about antifreeze poisoning", "Ethylene glycol ingestion treated only with fomepizole", "[Fatal chronic oxalosis after sublethal ethylene glycol poisoning]", "Experiences of the Czech toxicological information centre with ethylene glycol poisoning", "Ethylene glycol toxicosis in a free-ranging raccoon (Procyon lotor) from Prince Edward Island", "The Merck Veterinary Manual: Overview of Ethylene Glycol Toxicity", "General properties, irritant and toxic actions of ethylene glycol", "Concise International Chemical Assessment Document 22: Ethylene Glycol: Environmental Aspects", "Preliminary Data Summary: Airport Deicing Operations (Revised)", "Glycol Mitigation Strategies: The Canadian Approach". [52] In Australia there were 17 cases reported to the Victorian poison center and 30 cases reported to the New South Wales poison center in 2007. Costing US$1,000 per gram, an average course used in an adult poisoning would cost approximately $3,500 to $4,000. [2] Treatment consists of stabilizing the person, followed by the use of an antidote. The goal of pharmacotherapy is to prevent the formation of these metabolites. [39][40] Despite the cost, fomepizole is gradually replacing ethanol as the antidote of choice in ethylene glycol poisoning. [12], The three main systems affected by ethylene glycol poisoning are the central nervous system, metabolic processes, and the kidneys. [65] In the United States, eight states (Oregon, California, New Mexico, Virginia, Arizona, Maine, Tennessee, Washington) have made the addition of bittering agents to antifreeze compulsory. Additionally, as a side effect of the first two steps of metabolism, an increase in the blood concentration of lactic acid occurs contributing to lactic acidosis. [60] In the United States there were 5816 cases reported to poison centers in 2002. In smaller amounts, ethylene oxide is used as a pesticide and a sterilizing agent. Ethylene glycol is a toxic compound. Clin Pediatr (Phila) 2009 Nov;48(9):913-21. It is eventually excreted in the urine, but supportive therapy for the CNS depression and metabolic acidosis will be required until the ethylene glycol concentrations fall below toxic limits. Ethylene glycol in itself is not What are the stability and reactivity hazards of ethylene … [17] Additionally, ethylene glycol was the most common chemical responsible for deaths reported by US poison centers in 2003. Precautions must be taken to avoid any equipment, tools, etc., that may spark in the vicinity of EO chambers. [1] It may be drunk accidentally or intentionally in a suicide attempt. The disadvantage of fomepizole is that it is expensive. [42], Treatment for antifreeze poisoning needs to be started as soon after ingestion as possible to be effective; the earlier treatment is started, the greater the chance of survival. [1] Later symptoms may include a decreased level of consciousness, headache, and seizures. Both these acids accumulate causing acidosis, which can lead to kidney problems and the formation of calcium oxalate (kidney stones). Ethylene glycol is a colorless, sweet-tasting liquid most commonly found in antifreeze, but occasionally used for other purposes, such as industrial solvents. [7] The increase in metabolites may cause encephalopathy or cerebral edema. [7] It is only used in the presence of a toxic dose of another poison or drug. Ethylene is used as an anesthetic, a refrigerant, and to make other chemicals as polymers and plastics. Most ethylene glycol poisonings occur due to the ingestion of antifreeze. [7] Seizures may occur due to a direct effect. 1988 Jan;84(1):145-52. In cats, this stage occurs 12–24 hours after consuming antifreeze; in dogs, at 36–72 hours after consuming antifreeze. [15], Ethylene glycol has been shown to be toxic to humans[16] and is also toxic to domestic pets such as cats and dogs. That is roughly 16 mL of 50% ethylene glycol for an 80 kg adult and 4 mL for a 20 kg child. The term “toxic alcohols” is a collective term that includes methanol, ethylene glycol, and isopropyl alcohol. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Disposing of used antifreeze only by taking to a service station. [5] An outbreak of deaths in 1937 due to a medication mixed in a similar compound, diethylene glycol, resulted in the Food, Drug, and Cosmetic Act of 1938 in the United States, which mandated evidence of safety before new medications could be sold. Ethylene glycol exposures can cause varying degrees of toxicity and management generally requires supportive care, close laboratory monitoring and antidotal therapy. Poison control centers often use more than a lick or taste in a child or more than a mouthful in an adult as a dose requiring hospital assessment. [55][56][57] Many cases of poisoning are the result of using ethylene glycol as a cheap substitute for alcohol or intentional ingestions in suicide attempts. Ethylene | CH2=CH2 or (C2H4)n or C2H4 | CID 6325 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological activities, safety/hazards/toxicity information, supplier lists, and more. 2007 Sep;25(7):799-803. doi: 10.1016/j.ajem.2007.01.017. This depression appears similar to ethanol intoxication, but without the characteristic odor of alcohol. Ethylene glycol has a sweet taste and is often accidentally or intentionally ingested. What is ethylene oxide? Ethylene glycol is metabolised by oxidation forming 2 major toxic metabolites. The three main systems affected by ethylene glycol poisoning are the central nervous system, metabolic processes, and the kidneys. Similar to ethanol, it causes intoxication, followed by drowsiness or coma. [26][27], The increased osmolal gap is caused by the ethylene glycol itself. [9] Once kidney failure develops, the prognosis is poor. [7][8], The most common source of ethylene glycol is automotive antifreeze or radiator coolant, where concentrations are high. [64][68][69] Specifically, Mullins finds that bittering of antifreeze does not reduce reported cases of poisoning of preschoolers in the US state of Oregon. [2] Other treatments may include sodium bicarbonate, thiamine, and magnesium. As it has a toxic effect and, in high doses, can cause seizures and even coma, it has not been authorised for use in the food industry in Europe since 1981. [7] In this situation a helpful test to diagnose poisoning is the measurement of the osmolal gap. [24] It is most reliably diagnosed by the measurement of the blood ethylene glycol concentration. The primary danger is its sweet taste, so children and animals can eat it, and it is toxic. EO sterilization cycles must be designed to avoid conditions or parameters that may be explosive. 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