Full Answer
What are the effects of antifreeze on the kidneys?
Ethanol has been used clinically as an intravenous (IV) treatment of antifreeze poisoning (ethylene glycol) or as a preventative to antifreeze poisoning. The intravenous treatment is a mix of ethanol in different percentages, the most common being 5%, 10% or even 95%. As an antifreeze poisoning treatment, ethanol prevents the key ingredient in antifreeze, the ethylene …
What is the role of early hemodialysis in the treatment of antifreeze toxicity?
Dec 31, 2017 · Introduction. Ethylene glycol is a colorless, odorless, and water-soluble substance. It is currently used as a raw material in solvents, antifreezes, diluents, and various chemicals1).It is referred to as a “sweet killer” in the West because it is sweet and does not irritate the oral mucosa when ingested2).Ethylene glycol poisoning often occurs when an alcoholic person …
Can you just give ethanol to a patient?
Fomepizole is a newer agent with a specific indication for the treatment of ethylene glycol poisoning. Metabolic acidosis is resolved within three hours of initiating therapy. Initiation of fomepizole therapy before the serum creatinine concentration rises can minimize renal impairment. Compared with traditional ethanol treatment, advantages of ...
What happens to antifreeze in the body when it is metabolized?
An antidote to ethylene glycol is available for dogs, but is only effective if given before kidney failure develops. In cats, intravenous treatment with ethanol can be helpful if given early after ingestion of antifreeze. In dogs and cats with severe kidney failure, the outlook is poor.
Does ethanol prevent ethylene glycol poisoning?
What is the best treatment for ethylene glycol toxicity?
Does ethanol cancel out antifreeze?
Does ethylene glycol damage kidneys?
How do you reverse ethylene glycol poisoning?
How ethylene glycol is cleared from the body?
Why would administering whiskey ethanol to a person poisoned with methanol be a good antidote?
What is the antidote for methanol?
What are the symptoms of being slowly poisoned?
- Nausea and/or vomiting.
- Diarrhea.
- Rash.
- Redness or sores around the mouth.
- Dry mouth.
- Drooling or foaming at the mouth.
- Trouble breathing.
- Dilated pupils (bigger than normal) or constricted pupils (smaller than normal)
What organ does ethylene glycol effect?
What are the phases of acute renal failure?
Is ethylene glycol still used in antifreeze?
What to do if you ingest antifreeze?
But if you’re certain that you’ve ingested antifreeze or you’re showing symptoms of antifreeze poisoning, call 911 immediately.
What is antifreeze in cars?
Overview. Antifreeze is a liquid that prevents the radiator in cars from freezing or overheating. It’s also known as engine coolant. Although water-based, antifreeze also contains liquid alcohols like ethylene glycol, propylene glycol, and methanol. Propylene glycol is also an ingredient in some foods and cosmetics.
How long does it take for antifreeze to poison?
Antifreeze poisoning can happen gradually over several hours, so you may not have symptoms immediately after ingesting the chemical. If you feel fine, you may even brush off the incident as nothing more than a close call. But the situation isn’t that simple.
What is the best way to treat antifreeze poisoning?
An antidote is the first line of treatment for antifreeze poisoning. These include either fomepizole (Antizol) or ethanol. Both drugs can reverse the effects of the poison and prevent further problems, such as permanent organ damage.
How long does it take for a kidney to recover from dialysis?
Depending on the level of kidney damage, dialysis may be a temporary treatment or a permanent one. If temporary , it may take up to two months to recover kidney function.
What chemical is converted into antifreeze?
As your body absorbs or metabolizes antifreeze, the chemical is converted into other toxic substances such as: glycolaldehyde. glycolic acid. glyoxylic acid. acetone. formaldehyde. Your body slowly begins to react to the antifreeze in your system.
Why do people drink antifreeze?
There are different explanations for why someone might ingest antifreeze. One reason is intentional self-harm. But it’s also possible to accidentally drink the chemical.
What happens if you have a blood alcohol level of 50?
If there simultaneously exists a blood ethyl alcohol level greater than 50-100 mg/dL, no metabolic acidosis will occur until the EtOH level falls. This is because ethanol ties up the rate limiting, first-step enzyme, alcohol dehydrogenase, and prevents metabolism of ethylene glycol into its toxic acid products.
How long does it take for ethyl alcohol to cause acidosis?
Some degree of altered mental status is usually the first sign of ethylene glycol intoxication. (Gastritis some times occurs early, as would symptoms caused by other substances in the case of a mixed ingestion). After a delay of 4 to 12 hours, metabolic acidosis gradually develops. If there simultaneously exists a blood ethyl alcohol level greater than 50-100 mg/dL, no metabolic acidosis will occur until the EtOH level falls. This is because ethanol ties up the rate limiting, first-step enzyme, alcohol dehydrogenase, and prevents metabolism of ethylene glycol into its toxic acid products. This is the basis for use of ethyl alcohol as an antidote.
What is the metabolic process of ethylene glycol?
Acute renal failure as well as a severe anion-gap metabolic acidosis results from the metabolism of ethylene glycol into at least 4 distinct metabolites. Alcohol dehydrogenase, the same first step enzyme responsible for the metabolism of methyl and ethyl alcohols, slowly catalyzes conversion of EG to glycoaldehyde. This is, in turn, rapidly converted by aldehyde dehydrogenase into glycolic acid. Glycolate is then metabolized into glyoxylate and finally oxalate.
How many people died from ethylene glycol in 2000?
In calendar year 2000, the CPCS consulted on 469 exposures to EG. These included 5 patients who later died and 38 who had either moderate or major effects attributed to EG. Minor effects were attributed to 62 exposures. Only 2 serious cases, and no deaths, occurred in persons under age 20.
What is the boiling point of ethylene glycol?
Ethylene glycol is an odorless, colorless, sweet-tasting syrupy substance with a molecular weight of 62.07, freezing point of -13°C and a boiling point of 197.6°C. It is most commonly encountered as automotive antifreeze.
How long does it take for a patient to become ill in jail?
Within 24 hours the patient becomes acutely ill while in jail. He arrives back at the hospital profoundly acidotic and hypocalcemic. He suffers a cardiac arrest and cannot be resuscitated. After the patient died, the lab reports that the patient had a highly toxic ethylene glycol level drawn on the first visit.
How long does it take to get EG poisoning test results?
We are aware of only 4 hospital laboratories in California that can perform this test on a "stat" basis. As a result, a level drawn at a given hospital can take up to 8-9 milli-years (several days) to be reported.
How to treat ethylene glycol in dogs?
Treatment involves reducing further absorption of ethylene glycol by inducing vomiting or flushing the stomach (or both), followed by administration of activated charcoal and sodium sulfate within 1 to 2 hours of ingestion. Once absorption has occurred, excess fluids are given to force the excretion of ethylene glycol through increased urine production and to correct dehydration. An antidote to ethylene glycol is available for dogs, but is only effective if given before kidney failure develops. In cats, intravenous treatment with ethanol can be helpful if given early after ingestion of antifreeze. In dogs and cats with severe kidney failure, the outlook is poor.
Why is ethylene glycol poisoning so common?
Ethylene glycol poisoning is most common in temperate and cold climates because antifreeze is used both to decrease the freezing point and to increase the boiling point of radiator fluid. In colder climates, ethylene glycol poisoning is often seasonal, with most cases occurring in the fall, winter, and early spring.
Why is it so difficult to diagnose ethylene glycol?
Diagnosis is often difficult because signs are similar to signs in other types of central nervous system disease or trauma, gastroenteritis, pancreatitis, diabetes, and severe kidney failure due to other causes . If ingestion of ethylene glycol is not witnessed, diagnosis is usually based on a combination of history, physical examination, and laboratory data.
How to tell if a dog has ethanol poisoning?
Signs begin almost immediately and resemble alcohol (ethanol) poisoning. Dogs and cats vomit due to gastrointestinal irritation, are excessively thirsty, and pass large amounts of urine. Neurologic signs develop, including depression, stupor, and lack of coordination. As the animal becomes more depressed, it drinks less and becomes dehydrated. Dogs may appear to briefly recover from these signs about 12 hours after ingestion. Severe kidney failure usually develops between 36 and 72 hours in dogs and between 12 and 24 hours in cats. Signs include a lack of energy, loss of appetite, dehydration, vomiting, diarrhea, mouth ulcers, drooling, rapid breathing, and possibly seizures or coma. The kidneys are often swollen and painful.
How long does it take for a dog to have kidney failure?
Severe kidney failure usually develops between 36 and 72 hours in dogs and between 12 and 24 hours in cats. Signs include a lack of energy, loss of appetite, dehydration, vomiting, diarrhea, mouth ulcers, drooling, rapid breathing, and possibly seizures or coma. The kidneys are often swollen and painful.
Why is squamous cell carcinoma most common in animals?
Ocular squamous cell carcinoma is most common in animals with light pigmentation around the eyes, because sun exposure is one of several predisposing factors. This tumor is common in each of the following species EXCEPT: Cats. Cattle.
Is ethylene glycol toxic to dogs?
Overview of Ethylene Glycol Toxicity All animals are susceptible to ethylene glycol (EG) toxicity, but it is most common in dogs and cats. Most intoxications are associated with ingestion of antifreeze, which is typically 95% EG... read more
How is ethylene glycol metabolized?
Following ingestion, ethylene glycol is first hepatically metabolised to glycoaldehyde by alcohol dehydrogenase. Glycoaldehyde is then oxidised to glycolic acid, glyoxylic acid and finally oxalic acid.
Does fomepizole inhibit alcohol dehydrogenase?
Like ethanol, fomepizole inhibits alcohol dehydrogenase; however it does so without producing serious adverse effects. Unlike ethanol, fomepizole is metabolised in a predictable manner, allowing for the use of a standard, validated administration regimen.
Is ethylene glycol toxic?
While ethylene glycol itself causes intoxication, the accumulation of toxic metabolites is responsible for the potentially fatal acidosis and renal failure, which characterises ethylene glycol poisoning.
Is glycoaldehyde oxidized?
Glycoaldehyde is then oxidised to …. Ethylene glycol, a common antifreeze, coolant and industrial solvent, is responsible for many instances of accidental and intentional poisoning annually. Following ingestion, ethylene glycol is first hepatically metabolised to glycoaldehyde by alcohol dehydrogenase. Glycoaldehyde is then oxidised to ….
Does ethanol saturate alcohol?
Historically, this has been done with intoxicating doses of ethanol. At a sufficiently high concentration, ethanol saturates alcohol dehydrogenase, preventing it from acting on ethylene glycol, thus allowing the latter to be excreted unchanged by the kidneys.
Is ethanol a toxicity drug?
However, ethanol therapy is complicated by its own inherent toxicity, and the need to carefully monitor serum ethanol concentrations and adjust the rate of administration. A recent alternative to ethanol therapy is fomepizole, or 4-methylpyrazole.
What is the highest temperature after antifreeze poisoning?
On day 17 after antifreeze poisoning, the patient experienced fever, with a highest body temperature of 39°C. Chest computed tomography performed in February 2013 indicated a large patchy opacity on the right inferior lung and a small amount of pleural effusion in the right thoracic cavity associated with mediastinal lymphadenopathy. As a result, cefotiam (2.0 g; Harbin Pharmaceutical Group Co.,Ltd., Harbin, China) and levofloxacin (0.6 g; Yangtze River Pharmaceutical Co,.Ltd., Taizhou, China) were administered for anti-infection treatment. The patient was supplementally diagnosed with pulmonary infection due to the long-term bed rest and poor human resistance contributing to the infection. The infection was under control in March 2013, and the patient was discharged with all normal indices (including creatinine, BGA and blood routine test values) approximately 1 month after antifreeze poisoning. During a 4-month follow-up period (March to July 2013), the patients received a renal function test once per month, and did not present any relapse.
What happened to a 35 year old man who ate antifreeze?
A 35-year-old male purposely consumed automobile antifreeze solution (~200 ml) in February 2013. The patient presented with nausea and with significant vomiting, facial blushing and agitation at the primary stage; however, the patient did not inform his family members regarding the incident. After ~19 h, the patient was found by family members in a state of severe agitation and immediately presented to the First Affiliated Hospital of Bengbu Medical College (Bengbu, China). Informed consent was obtained from the patient. In the Outpatient Department, the patient was subjected to gastric lavage and transferred to the Department of Emergency Internal Medicine following consultation and diagnosis of antifreeze poisoning. The symptoms the patient presented with upon admission included nausea, vomiting, facial blushing, severe agitation and shortness of breath. The patient did not experience symptoms of fever, disturbance of consciousness, coughing, palpitation, chest tightness, precordial discomfort or hematemesis, while normal emiction and defecation were reported. The patient was fasted during hospitalization. Physical examination obtained 20 h after antifreeze consumption recorded a temperature of 36.7°C, heart rate of 115 bpm, respiratory rate of 35 breaths/min, and blood pressure of 154/87 mmHg. The patient was conscious with respiratory rapidity, and was cooperative during the physical examination. Routine check-ups concluded that the systemic skin and mucosa of the patient were not yellow in color, the skull was not malformed, and the bilateral pupils were round with the same diameter of ~3 mm; however, the pupillary light reflex was slightly slow. In addition, the patient's lips were not cyanotic and his neck was soft without resistance (with regard to meningeal stimulation of neck stiffness). Upon auscultation, coarse respiratory sounds were reported in the two lungs, without significant dry or moist rales heard. Furthermore, the cardiac rhythm was regular and pathological murmurs were not observed. The abdomen was soft with no tenderness, while the bilateral kidney regions showed weakly positive percussion pains and the tendon jerk reflex was hyperreactive. Results of other examinations were unremarkable.
What are the components of antifreeze?
Common antifreeze components include ethylene glycol, rust inhibitor, fungicide, pH value regulator and pour point depressant. Ethylene glycol is a colorless, sweet and low-toxicity fluid, however its metabolites are highly toxic (1,2). The adult lethal dose is 80–100 ml if antifreeze solution is consumed orally. Ethylene glycol (which has a high water solubility) is absorbed by the gastrointestinal tract, and quickly spreads to the blood and interstitial fluid. It is metabolized by ethanol dehydratase into glycolaldehyde in the liver, and then by aldehyde dehydrogenase into glycolic acid, which is later oxygenized by glycolate oxidase into glyoxylic acid. The major end product is oxalic acid (1), while other products include formic acid and hippuric acid. Due to the formation of a large amount of organic acids, metabolic acidosis and hyperkalemia occur. In addition, the combination of oxalic acid with calcium leads to hypocalcemia, and the deposition of calcium oxalate crystals in renal tubules results in renal injury, and even acute renal failure (2,3). If not timely treated, severely poisoned patients succumb due to severe hyperkalemia or metabolic acidosis at the early stage, while certain individuals may succumb after several days due to acute renal failure or central nervous system exhaustion (3,4).
What are the symptoms of ethylene glycol poisoning?
At the second stage, the cardiac and pulmonary symptoms become significant, and the patient presents respiratory rapidity, tachycardia, mild hypertension and cyanosis. In severe cases, pulmonary edema, heart and lung enlargement , and congestive heart/circulatory failure also appear. At the third stage of the poisoning, the patient present different degrees of renal failure, and if the patient survives the acute stage, symptoms of renal damage occur within 2–3 days, including proteinuria, hematuria, oliguria and anuria.
Where is the first affiliated hospital of Bengbu Medical College?
1Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
What is the meaning of "dose" in medicine?
Dose, route of administration and treatment duration of the therapies received by the patient.
What happens if you have too little ethanol?
If metabolic acidosis persists, too little ethanol or fomepizole is being administered. Traditionally, hemodialysis is continued until ethylene glycol and glycolic acid levels cannot be detected in the blood, and there are no acid-base disturbances. 3, 6.
How much does a serum ethylene glycol test cost?
It requires a separate, dedicated gas chromatography column. This test is expensive (approximately $90, excluding transportation and handling fees). Although the test is not a good indicator of prognosis, a documented level above 20 mg per dL (3 mmol per L) is an indication for treatment with fomepizole (Antizol). 4
What is the treatment for ethylene glycol poisoning?
Traditional treatment of ethylene glycol poisoning consists of sodium bicarbonate, ethanol, and hemodialysis. Fomepizole is a new agent with a specific indication by the U.S. Food and Drug Administration for the treatment of ethylene glycol poisoning. 4, 6, 7, 13, 14 Ethanol and fomepizole are thought to act as inhibitors of alcohol dehydrogenase and therefore prevent the formation of acidic ethylene glycol metabolites, 4, 6, 7, 13 but only fomepizole has demonstrated this ability. 7 If patients are diagnosed and treated with these products early in the course of poisoning, hemodialysis may be avoided. Once severe acidosis and renal failure have occurred, however, hemodialysis is necessary.
How to calculate osmolar gap?
5 – 7, 9 The osmolar gap (O g) is calculated by subtracting the calculated serum osmolality (O c) from measured osmolality (O m ), or O g = O m − O c ( Table 2). If the serum osmolar gap is greater than 10 mOsm per kg of water, the presence of ethylene glycol poisoning is likely. 5, 9 Some recent reports 6, 11 suggest that a normal osmolar gap is -10 to +20 mOsm per kg of water, but current recommendations use an osmolar gap greater than 10 for initiating treatment with an antidote. 4 While elevated serum osmolality combined with an elevated anion gap strongly suggests ethylene glycol poisoning, the absence of either does not rule out a significant ingestion. If the patient presents soon after ingestion, ethylene glycol may not yet have been converted to its acid metabolites; late presentation may reveal no osmolar gap because the ethylene glycol has already been converted to toxic, but osmotically inactive, products. High serum ethanol concentrations will cause an overestimation of the osmolar gap. 9
What is the toxic effect of ethylene glycol?
References. Toxicity results from the depressant effects of ethylene glycol on the central nervous system (CNS). Metabolic acidosis and renal failure are caused by the conversion of ethylene glycol to noxious metabolites. Oxidative reactions convert ethylene glycol to glycoaldehyde, and then to glycolic acid, which is the major cause ...
What is fomepizole used for?
Fomepizole is a newer agent with a specific indication for the treatment of ethylene glycol poisoning. Metabolic acidosis is resolved within three hours of initiating therapy. Initiation of fomepizole therapy before the serum creatinine concentration rises can minimize renal impairment. Compared with nervous system and hypoglycemia, ...
How long does it take for ethylene glycol to kill you?
3, 5, 9 If untreated, severe ethylene glycol toxicity is usually fatal within 24 to 36 hours. 3, 5 – 8, 10.
How does methanol affect the body?
Its adverse effects are due primarily to the impact of its major metabolite formic acid and lactic acid resulting from cellular hypoxia. Symptoms including abdominal pain and loss of vision can appear a few hours to a few days after exposure, reflecting the time necessary for accumulation of the toxic byproducts. In addition to a history of exposure, increases in serum osmolal and anion gaps can be clues to its presence. However, increments in both parameters can be absent depending on the nature of the toxic alcohol, time of exposure, and coingestion of ethanol. Definitive diagnosis requires measurement with gas or liquid chromatography, which are laborious and expensive procedures. Tests under study to detect methanol or its metabolite formate might facilitate the diagnosis of this poisoning. Treatment can include administration of ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites, and hemodialysis to remove methanol and formate. In this Acid-Base and Electrolyte Teaching Case, a patient with methanol intoxication due to ingestion of model airplane fuel is described, and the value and limitations of current and new diagnostic and treatment measures are discussed.
What is the treatment for methanol poisoning?
Treatment can include administration of ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites, and hemodialysis to remove methanol and formate.
What is the major metabolite of methanol?
The majority of the clinical abnormalities are due to the effects of formic acid, the major metabolite of methanol ( Fig 1 ). Interference with cytochrome oxidase by formate causes tissue hypoxia and lactic acidosis.
Why are b values inaccurate?
b Values proved to be inaccurate due to interference of nitromethane in ingested airplane fuel with measurement of serum creatinine.
How is recognition of intoxication hampered?
However, recognition of the intoxication is often hampered by the lack of specific signs and symptoms and the limitation of present diagnostic modalities.
What enzyme catalyzes methanol?
Figure 1 Metabolism of methanol. Methanol undergoes serial oxidation: methanol is catalyzed by the enzyme alcohol dehydrogenase to formal dehyde and then formaldehyde is catalyzed by the enzyme formaldehyde dehydrogenase to formic acid. Folinic acid given to a patient will accelerate the conversion to carbon dioxide (CO2) and water (H2O).
What is the conversion factor for serum creatinine?
Note: Conversion factors for units: serum creatinine in mg/dL to μmol/L, ×88.4; SUN in mg/dL to mmol/L, ×0.357.
Introduction
Case Presentation
Questions
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
- Treatment goals include: 1. prevention of further metabolism of ethylene glycol via us of antidotes (ethyl alcohol or fomepizole) 2. removal of ethylene glycol from the blood using hemodialysis 3. correction of metabolic acidosis via administration of sodium bicarbonate and use of dialysis 4. correction of hypocalcemia 5. co-factor therapy to enhan...
Discussion of Case Questions