Ethylene Glycol

Antifreeze is the most common source of ethylene glycol. Due to its inebriant properties, ingestion of ethylene glycol can be fatal and accounts for about 40 to 60 deaths per year. While ethylene glycol itself is not toxic, it metabolizes to aldehydes and oxalate. The toxic dose is approximately 100 ml, and death is due to renal or cardiopulmonary mechanisms. After ingestion, symptoms may appear rapidly or may take hours to develop. Initial symptoms include restlessness and agitation, followed by somnolence, stupor, coma, and convulsions. The patient becomes cyanotic, pupils are nonreactive, and corneal reflexes are absent. In milder cases, fatigue, personality change, and depression are present. Ethylene glycol poisoning should be suspected when an apparently inebriated patient has no alcohol on the breath. Neuropathological changes have been reported and include cerebral edema, vascular engorgement, and hemorrhage. Treatment consists of correcting the acidosis and using early dialysis to remove the ethylene glycol, oxalate, and aldehyde and also treat the associated uremia.

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