Poisons affecting the kidney

2019 ◽  
Vol 10 (8) ◽  
pp. 418-424
Author(s):  
Nicola Bates
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Ethylene Glycol ◽  
Parent Compound ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
Dried Fruit ◽  
Inhibition Of Prostaglandin Synthesis

The kidney has an essential role in maintaining normal physiological functions but it can be affected by various drugs and chemicals. A common seasonal cause of renal failure in cats is ingestion of antifreeze containing ethylene glycol. It is not the ethylene glycol itself which causes renal failure but toxic metabolites which result in deposition of calcium oxalate crystals in the renal tubules. Various non-steroidal anti-inflammatory drugs (NSAIDs), particularly those used in human medicine such as ibuprofen, flurbiprofen and naproxen, cause renal effects through inhibition of prostaglandin synthesis which results in reduced renal blood flow and disruption of normal renal function and homeostatic mechanisms. For some common substances, such as lilies in cats and grapes and their dried fruit in dogs, kidney injury occurs through unknown mechanisms. Management of poison-induced kidney injury is supportive with monitoring and support of renal function. Although haemodialysis and other extracorporeal techniques can be used, they are rarely available in veterinary medicine and therefore preventive measures are used. This includes aggressive intravenous fluid therapy before onset of signs for lily and grape poisoning and early use of the antidote (ethanol) in ethylene glycol poisoning to prevent formation of toxic metabolites, allowing excretion of the parent compound. In most cases, once kidney injury is advanced, prognosis is poor.

Poisons affecting the kidney

2021 ◽  
Vol 26 (4) ◽  
pp. 1-7
Author(s):  
Nicola Bates
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Ethylene Glycol ◽  
Parent Compound ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
Dried Fruit ◽  
Inhibition Of Prostaglandin Synthesis

The kidney has an essential role in maintaining normal physiological functions but it can be affected by various drugs and chemicals. A common seasonal cause of renal failure in cats is ingestion of antifreeze containing ethylene glycol. It is not the ethylene glycol itself which causes renal failure but toxic metabolites which result in deposition of calcium oxalate crystals in the renal tubules. Various non-steroidal anti-inflammatory drugs, particularly those used in human medicine such as ibuprofen, flurbiprofen and naproxen, cause renal effects through inhibition of prostaglandin synthesis which results in reduced renal blood flow and disruption of normal renal function and homeostatic mechanisms. For some common substances, such as lilies in cats and grapes and their dried fruit in dogs, kidney injury occurs through unknown mechanisms. Management of poison-induced kidney injury is supportive with monitoring and support of renal function. Although haemodialysis and other extracorporeal techniques can be used, they are rarely available in veterinary medicine and therefore preventive measures are used. This includes aggressive intravenous fluid therapy before onset of signs for lily and grape poisoning and early use of the antidote (ethanol) in ethylene glycol poisoning to prevent formation of toxic metabolites, allowing excretion of the parent compound. In most cases, once kidney injury is advanced, prognosis is poor.

scholarly journals Ethylene Glycol Intoxication Requiring ECMO Support

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Raphael Rosen ◽  
Shelief Robbins-Juarez ◽  
Jacob Stevens
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Extracorporeal Membrane Oxygenation ◽  
Kidney Injury ◽  
Neurological Injury ◽  
Severe Metabolic Acidosis ◽  
Toxic Metabolites ◽  
Ethylene Glycol Intoxication

Ethylene glycol is commonly used in antifreeze, and ingestion of even a small amount can result in acute kidney injury, severe metabolic acidosis, and neurological injury. When cases are recognized early, treatment involves administration of alcohol dehydrogenase inhibitors to prevent conversion to toxic metabolites of glycolate, glyoxolate, and oxalate. In later presentations with more severe renal injury, hemodialysis may be required for clearance of toxic metabolites and supportive care for renal failure. We present the first reported case of severe ethylene glycol intoxication requiring support of extracorporeal membrane oxygenation (ECMO) due to refractory cardiopulmonary collapse.

scholarly journals Lupus cystitis: unusual cause of renal failure in systemic lupus erythematosus

2019 ◽  
Vol 12 (12) ◽  
pp. e233446
Author(s):  
Kevin John ◽  
Krupa Varughese ◽  
Ranil Johann Boaz ◽  
Tarun George
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Function ◽  
Lupus Erythematosus ◽  
Kidney Injury ◽  
Systemic Lupus ◽  
Uncommon Presentation ◽  
Acute Dyspnoea ◽  
Chronic Fever

A 42-year-old woman presented with chronic fever, abdominal pain, intermittent loose stools and dysuria for 3 months. She had recently developed acute dyspnoea with acute kidney injury. She was found to have a contracted, thick-walled bladder with bilateral hydroureteronephrosis. She underwent bilateral percutaneous nephrostomies, following which her renal function recovered. She satisfied the clinical and immunological features of the Systemic Lupus International Collaborating Clinics criteria for systemic lupus erythematosus (SLE). She was initiated on immunosuppression. Lupus cystitis with a contracted bladder is an uncommon presentation of SLE.

scholarly journals Treatment of Ethylene Glycol Poisoning with Oral Ethyl Alcohol

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
B. Achappa ◽  
D. Madi ◽  
T. Kanchan ◽  
N. K. Kishanlal
Keyword(s):  
Oxalic Acid ◽  
Ethylene Glycol ◽  
Ethyl Alcohol ◽  
Glycolic Acid ◽  
Clinical Suspicion ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
High Degree

Ethylene glycol poisoning is not uncommon in India. The ill effects are primarily caused by its toxic metabolites: glycolic acid and oxalic acid. A 70-year-old female presented to our hospital with ataxia after ingestion of ethylene glycol. The reported case describes the management of ethylene glycol poisoning using oral ethyl alcohol as an alternative to the recommended intravenous ethyl alcohol and fomepizole that are not available for use in India. The need for high degree of clinical suspicion, targeted investigations, and early instigation of treatment is of prime importance in cases of ethylene glycol poisoning as it can lead to long-term complications or even death.

Acute kidney injury

2018 ◽  
Author(s):  
Aron Chakera ◽  
William G. Herrington ◽  
Christopher A. O’Callaghan
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Urine Volume ◽  
Kidney Injury ◽  
Rapid Decrease

Acute renal failure (also referred to as acute kidney injury) refers to a rapid decrease in renal function; it is reflected by an increase in blood urea and creatinine and is often associated with oliguria (a urine volume of less than 400 ml/24 hours). It usually develops over days to weeks. Acute kidney injury has been variously classified, but the current classifications are based on the glomerular filtration rate (or creatinine), looking at changes from baseline, and the presence of oliguria or anuria. The potential etiologies of acute kidney injury are usually considered anatomically under the headings prerenal, renal (intrinsic), and postrenal. This chapter looks at the etiology, symptoms, clinical features, demographics, complications, diagnosis, and treatment of acute kidney injury.

Efficacy of 4-Methylpyrazole in Ethylene Glycol Poisoning: Clinical and Toxicokinetic Aspects

1994 ◽  
Vol 13 (1) ◽  
pp. 61-64 ◽  
Author(s):  
P. Harry ◽  
A. Turcant ◽  
G. Bouachour ◽  
P. Houze ◽  
P. Alquier ◽  
...  
Keyword(s):  
Renal Function ◽  
Ethylene Glycol ◽  
Clinical Course ◽  
Hepatic Metabolism ◽  
Transaminase Activity ◽  
Ethylene Glycol Poisoning ◽  
The Mean ◽  
Ethylene Glycol Intoxication ◽  
Present On Admission ◽  
Plasma Half Life

Potentially fatal ethylene glycol intoxication in an adult with normal renal function was treated with 4-methylpyrazole administered three hours after the incident occurred. The plasma ethylene glycol concentration was 3.5 g 1-1 on admission. The metabolic acidosis present on admission resolved within four hours, and the subsequent clinical course was uneventful. The apparent plasma half-life of ethylene glycol was 16 h and the mean renal and plasma clearances of ethylene glycol were 24 and 25 ml min-1, respectively. These results support the hypothesis that complete blockade of hepatic metabolism of ethylene glycol is achieved by 4-methylpyrazole. The only side-effect observed as a result of treatment was a transient slight increase in serum transaminase activity.

Morphine-6-Glucuronide might Mediate the Prolonged Opioid Effect of Morphine in Acute Renal Failure

1990 ◽  
Vol 9 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Egil Bodd ◽  
Dag Jacobsen ◽  
Ellen Lund ◽  
Åse Ripel ◽  
Jørg Mørland ◽  
...  
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Acute Kidney Failure ◽  
Morphine Treatment ◽  
Time Curve ◽  
Concentration Time ◽  
Toxic Metabolites ◽  
Elimination Half ◽  
Ethylene Glycol Poisoning

1 A 43-year-old male developed acute kidney failure due to ethylene glycol poisoning. He was treated with bicarbonate to combat metabolic acidosis, ethanol as an antimetabolite and haemodialysis to remove the glycol and its toxic metabolites. He was kept on a respirator and sedated with morphine. Peritoneal dialysis was given for 36 d. Following sedation with morphine for 11 d, the patient was given naloxone and then extubated. The antidote had to be continued for 14 d to prevent respiratory depression, until kidney function improved. 2 Only morphine-6-glucuronide (M-6-G) was found in the plasma and CSF at concentrations which might explain the opioid effects observed in the patient during the days after the cessation of morphine treatment. The ratio of the area under the concentration-time curve (AUC) of morphine-3-glucuronide (M-3-G) to M-6-G was 2:1. The elimination half-lives of M-3-G and M-6-G were 55 and 82 h, respectively. The clearance data indicate that most of the glucuronides were eliminated by peritoneal dialysis during renal failure. 3 The data suggest that M-6-G exerts opioid effects and is retained in acute kidney failure. Morphine should therefore not be used preferentially as a sedative/analgesic in pronounced kidney failure.

scholarly journals CONCOMITANT INGESTION OF ETHYLENE GLYCOL AND ETHANOL: A DIAGNOSIS TRAP?

2015 ◽  
Vol 64 (3) ◽  
pp. 282-284
Author(s):  
Otilia-Elena Frasinariu ◽  
◽  
Aniela Rugina ◽  
Cristina Jitareanu ◽  
Radu Russu ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Severe Metabolic Acidosis ◽  
Subsequent Evolution ◽  
Positive History ◽  
Toxic Metabolites ◽  
Central Nervous System Depression ◽  
Ethylene Glycol Poisoning ◽  
Suicidal Attempts ◽  
Rule Out

Ethylene glycol is one of the most toxic alcohols; it may be accidentally or intentionally consumed as a substitute for ethanol or related to suicidal attempts. Ingestion of ethylene glycol causes a severe metabolic acidosis with increased anion and osmotic gap due to its toxic metabolites, leading to a clinical picture of central nervous system depression, cardiovascular and renal impairment. A 16-year-old boy was admitted with clinical and biological signs of ethylene glycol poisoning after simultaneous ingestion of antifreeze and ethanol. The patient had mild anion gap metabolic acidosis only at the debut, rapidly corrected with one dose of sodium bicarbonate; further evaluation did not reveal acidosis, even if the subsequent evolution included acute renal failure requiring hemodialysis. Due to the absence of a positive history and of a persistent metabolic acidosis, the diagnosis of ethylene glycol poisoning was delayed until it was confirmed by serum toxicological test. Conclusions: concomitant ingestion of ethanol may mask the symptoms of ethylene glycol poisoning; the absence of persistent metabolic acidosis does not rule out the diagnosis.

Role of toxicology assessment in poisoning

2016 ◽  
Author(s):  
Albert Jaeger
Keyword(s):  
Ethylene Glycol ◽  
Parent Compound ◽  
Kinetic Studies ◽  
Acute Poisoning ◽  
Ethylene Glycol Poisoning ◽  
Salicylate Poisoning ◽  
Theophylline Poisoning ◽  
Quantitative Analyses ◽  
Toxicology Assessment

Diagnosis of acute poisoning is based on history, symptoms, biomedical investigations, toxicological analyses, and sometimes therapeutic tests. Toxicological analytical methods are now widely available. A qualitative or semiquantitative analysis of the parent compound may be adequate for diagnostic assessment. A quantitative analysis is mandatory for kinetic studies. For instance, in ethylene glycol poisoning, analysis of ethylene glycol concentrations is useful for the diagnosis, but glycolate concentrations are more relevant for the evaluation of the severity and prognosis. Groups of symptoms (or toxidromes) may provide diagnostic clues for toxins that are not usually included in routine screening. The management of the poisoned patient is mostly supportive, but toxicological quantitative analyses are mandatory for some treatments, e.g. alkaline diuresis in salicylate poisoning, repeated activated charcoal in theophylline poisoning, haemodialysis, ethanol in ethylene glycol poisoning, or the use of chelating agents.

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