Ethylene glycol poisoning is caused by the ingestion of ethylene glycol (the primary ingredient in both automotive antifreeze and hydraulic brake fluid). Ethylene glycol should not be confused with propylene glycol, a common food additive. Ethylene glycol is a toxic, colorless, odorless, almost nonvolatile liquid with a sweet taste that is occasionally consumed by children and dogs due to its sweetness. Following ingestion the symptoms of poisoning follow a three step progression starting with intoxication and vomiting, before causing metabolic acidosis, cardiovascular dysfunction, and finally acute kidney failure. The major cause of toxicity is not the ethylene glycol itself but its metabolites. The major metabolites causing toxicity are glycolic acid and oxalic acid.
Medical diagnosis of poisoning is most reliably done by measurement of ethylene glycol in the blood. However, many hospitals do not have the facilities to perform this test and need to rely on abnormalities in the body’s biochemistry to diagnose poisoning. Diagnosis can also be aided by examining the urine for the presence of calcium oxalate crystals. Treatment consists of initially stabilizing the patient, followed by the use of antidotes. The antidotes used are either ethanol or fomepizole (Antizol). The antidotes work by blocking the enzyme responsible for metabolizing ethylene glycol and therefore halt the progression of poisoning. Hemodialysis is also used to help remove ethylene glycol and its metabolites from the blood. As long as medical treatment is undertaken, the prognosis is generally good with most patients making a full recovery. Poisoning is relatively common, and due to its taste, children and animals will sometimes consume large quantities of ethylene glycol. Denatonium benzoate, a bitterant, is added to many antifreeze products to discourage accidental or deliberate ingestion.
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