Fatal Ethylene Glycol Intoxication Secondary to Accidental Ingestion

2017 ◽  
Vol 68 (7) ◽  
pp. 1591-1594 ◽  
Author(s):  
Cristina Furnica ◽  
Anton Knieling ◽  
Simona Irina Damian ◽  
Madalina Diac ◽  
Sofia David ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Calcium Oxalate ◽  
Histopathological Examination ◽  
Glyoxylic Acid ◽  
Calcium Oxalate Crystals ◽  
Severe Metabolic Acidosis ◽  
Histopathological Findings ◽  
Oxalate Crystals ◽  
Ethylene Glycol Intoxication

Ethylene glycol intoxication is potentially fatal and associated with typical clinical, laboratory and histopathological findings. The authors present the case of a 57-year-old male with a history of chronic alcoholism and who accidentally ingested approximately 1 litter of antifreeze solution. The patient was discovered comatose in his house and addressed to the emergency department with a Glasgow coma score of 3, severe metabolic acidosis, acute renal failure, atrial fibrillation and liver dysfunction. Despite reanimation manoeuvres and haemodialysis for 2 h the patient deceased 5 h after hospital admission. Necropsy examination revealed a stomach with oedematous walls, mucosa erosions and signs of bleeding together with a disorganised, granular single kidney with unidentifiable corticomedullary border. Histopathological examination displayed typical findings in the kidney such as autolytic changes of the epithelium and abundant calcium oxalate crystals in the lumen of the proximal tubules. Ethylene glycol intoxication is frequent in our country and its metabolites glycoaldehyde, glycolic acid, glyoxylic acid and oxalic acid are responsible for the severe metabolic acidosis and formation of calcium oxalate crystals in various organs and leading to severe multiple organ dysfunction and death. Forensic pathologists should be aware of clinical and biological manifestations as well as of typical histopathological findings as ethylene glycol is commonly ingested accidentally or used in homicidal/autolytical attempts.

Time-dependent changes in kidney histopathology in ethylene glycol poisoning

2018 ◽  
Vol 58 (4) ◽  
pp. 257-260 ◽  
Author(s):  
Janos Bokor ◽  
Krisztina Danics ◽  
Eva Keller ◽  
Zoltan Szollosi
Keyword(s):  
Epithelial Cells ◽  
Basement Membrane ◽  
Ethylene Glycol ◽  
Calcium Oxalate ◽  
Early Stage ◽  
Time Dependent ◽  
Calcium Oxalate Crystals ◽  
Oxalate Crystals ◽  
Cellular Debris ◽  
Tubular Lumen

Ethylene glycol (EG) may be acutely toxic following ingestion. In fatal cases, microscopic examination of urine and kidney specimens can establish a post-mortem diagnosis of EG poisoning. We describe the main renal histopathologic changes during different stages of EG poisoning, which might be helpful when dating the EG poisoning itself. A single-centre retrospective study conducted on all EG poisoning cases demonstrated that in an early stage of EG poisoning, fine dust-like crystals were deposited to the tubular cell basement membrane, followed by internalisation of calcium oxalate crystals into the epithelial cells. Later, the crystals formed larger aggregates within the epithelial cells. As the changes became advanced, pronounced tubular epithelial damage occurred, with detachment of epithelial cells from the basement membrane. In the final stage, coarse calcium oxalate crystals were recognised in the tubular lumen, with cellular debris from damaged epithelial cells. Our study shows that the time-dependent histological changes described follow the clinical stages of EG poisoning and may therefore provide a rough estimate of the time of EG ingestion before death.

Unusual Calcium Oxalate Crystals in Ethylene Glycol Poisoning

1980 ◽  
Vol 16 (4) ◽  
pp. 479-486 ◽  
Author(s):  
W. Godolphin ◽  
E. P. Meagher ◽  
H. D. Sanders ◽  
J. Frohlich
Keyword(s):  
Ethylene Glycol ◽  
Calcium Oxalate ◽  
Calcium Oxalate Crystals ◽  
Oxalate Crystals ◽  
Ethylene Glycol Poisoning

Ethylene Glycol Intoxication

1992 ◽  
Vol 7 (5) ◽  
pp. 234-243 ◽  
Author(s):  
James A. Kruse
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Specific Treatment ◽  
Severe Metabolic Acidosis ◽  
Presumptive Diagnosis ◽  
Cardiorespiratory Failure ◽  
Toxic Metabolites ◽  
Ethylene Glycol Intoxication

Commonly available as automotive antifreeze, ethylene glycol can cause toxicity and death if ingested. It is metabolized to several aldehyde and acid intermediates that can cause severe metabolic acidosis, central nervous system derangements, cardiorespiratory failure, and acute renal failure. A presumptive diagnosis can often be made by assessment of the anion gap and the osmol gap and the finding of metabolic acidosis. Corroborating findings include oxalate crystalluria and urine that fluoresces on exposure to ultraviolet light. Recognition is important because there are specific treatment methods available. Therapy consists of administering sodium bicarbonate to counter the acidosis, ethanol to slow the generation of toxic metabolites, and vitamin cofactors, which may speed detoxification of these intermediates. Hemodialysis is employed to remove both ethylene glycol and its metabolites, to correct the acidbase disturbances, and as treatment for acute renal failure.

Calcium Oxalate Crystals in Ethylene Glycol Toxicity

2017 ◽  
Vol 377 (15) ◽  
pp. 1467-1467 ◽  
Author(s):  
Mohamad Hanouneh ◽  
Teresa K. Chen
Keyword(s):  
Ethylene Glycol ◽  
Calcium Oxalate ◽  
Calcium Oxalate Crystals ◽  
Oxalate Crystals

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 Successful Resuscitation of a Patient with Life-Threatening Metabolic Acidosis by Hemodialysis: A Case of Ethylene Glycol Intoxication

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ikuyo Narita ◽  
Michiko Shimada ◽  
Norio Nakamura ◽  
Reiichi Murakami ◽  
Takeshi Fujita ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Kidney Injury ◽  
University Hospital ◽  
Severe Metabolic Acidosis ◽  
Continuous Hemodiafiltration ◽  
Successful Resuscitation ◽  
Life Threatening ◽  
Ethylene Glycol Intoxication

Background. Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. Case Presentation. A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury. He was transferred to the university hospital; hemodialysis was initiated because of hyperkalemia and severe metabolic acidosis. On recovering consciousness, he admitted having ingested antifreeze solution. Thirty-seven days after admission, the patient was discharged without requiring HD. Conclusions. We reported a case of ethylene glycol intoxication who presented with a life-threatening metabolic acidosis. In a state of severe circulatory shock requiring catecholamines, hemodialysis should be avoided, and continuous hemodiafiltration may be a preferred approach. However, one should be aware of the possibility of intoxication by unknown causes, and hemodialysis could be life-saving with its superior ability to remove toxic materials in such cases.

Identification of Crystalline Particles in Biological Tissue

1974 ◽  
Vol 32 ◽  
pp. 106-107
Author(s):  
S. Siew ◽  
R.K. Matta
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Blood Level ◽  
Biological Tissue ◽  
Practical Importance ◽  
Oxalate Crystals ◽  
Autopsy Tissue ◽  
Ethylene Glycol Intoxication ◽  
Ca Oxalate

The problem of ethylene glycol toxicity has increased in significance and practical importance with the more widespread use of this compound. This study was undertaken on autopsy tissue of a case of ethylene glycol intoxication. A young man of 22 drank about a quart of Prestone II antifreeze. He survived for 48 hours with manifestations of metabolic acidosis, progressive renal shutdown and coma. The blood level of ethylene glycol was 300 mg % and Ca oxalate crystals were seen in the urine. The autopsy was performed 8 hours after death.

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