Ethylene Glycol Poisoning

Ethylene Glycol Poisoning

Ethylene glycol poisoning is a condition when a person ingests large amounts of ethylene glycol. Poisoning with this substance can damage various organs of the body, such as the brain, kidneys, lungs and heart. If not treated immediately, ethylene glycol poisoning can cause fatal conditions.

Ethylene glycol is a chemical liquid that is often found in industrial materials, antifreeze for radiators, house cleaning fluids, paints, plastics, inks, detergents, and cosmetics. This substance is odorless, colorless, and tastes sweet.

Ethylene glycol poisoning is suspected as a cause of acute renal failure that occurs in children in Indonesia and Gambia. In Indonesia alone there are more than 200 cases of children suffering from acute kidney failure, especially in children aged 1-5 years.

Causes of Ethylene Glycol Poisoning

Ethylene glycol poisoning often occurs when a person ingests large amounts of liquid ethylene glycol, either intentionally or accidentally. A person can also be exposed to ethylene glycol by inhaling vapors or sprays containing this substance. However, ethylene glycol poisoning is more severe in people who ingest this substance.

If a person swallows ethylene glycol, the digestive tract will immediately absorb the substance and form a compound called glycolic acid. These compounds can disrupt the acid-base balance in the body, causing severe metabolic acidosis .

In addition to causing metabolic acidosis, glycolic acid is also converted by the body into oxalate. Oxalate can bind with calcium to form calcium oxalate. Calcium oxalate then accumulates and causes disturbances in various organs of the body, such as the brain, lungs and heart.

Ethylene glycol fluid that enters the body around 1.4 ml/kg body weight can cause death.

Risk factors for ethylene glycol poisoning

There are several factors that can increase the risk of ethylene glycol poisoning, namely:

  • Work in an industry that uses ethylene glycol
  • Accidental ingestion of ethylene glycol, usually in children
  • Consuming liquor made illegally, because ethylene glycol is usually used as a substitute for alcohol
  • Made a suicide attempt

Symptoms of Ethylene Glycol Poisoning

Symptoms of ethylene glycol poisoning can appear quickly. There are three stages of development in someone who ingests ethylene glycol, namely:

  • Stage 1, symptoms appear in the nerves within 30 minutes to 12 hours after a person ingests liquid ethylene glycol
  • Stage 2, symptoms appear in the heart and lungs within 12-24 hours after ingesting ethylene glycol liquid
  • Stage 3: Kidney symptoms appear within 24–72 hours after ingesting ethylene glycol

Some of the symptoms that can appear according to the organs affected are:

1. Symptoms of the nerves, such as:

  • Drowsiness
  • dazed
  • Talk is not clear
  • Nervous
  • Inability to tell time and place (disorientation)
  • Emotional changes
  • seizures

2. Symptoms of the heart and lungs, including:

  • Very fast breathing and panting
  • Hard to breathe
  • High blood pressure (hypertension) or low ( hypertension )
  • Irregular heartbeat ( arrhythmia )
  • Sudden cardiac arrest

3. Kidney symptoms, which generally appear when a person experiences long-term ethylene glycol poisoning, include:

  • Severe nausea and vomiting
  • The volume of urine is reduced
  • Infrequent urination

When to see a doctor

Immediately take it to the emergency room if your child or people around you experience the symptoms above. If the patient is known to have swallowed a product containing ethylene glycol, you need to bring the product the patient has swallowed, know when the patient ingested it, and find out how much the patient has ingested the product.

Please note, activated carbon or activated charcoal can overcome several types of poisoning. However, activated carbon cannot overcome cases of ethylene glycol poisoning. Therefore, activated carbon is not recommended as first aid or treatment for ethylene glycol poisoning.

First aid for ethylene glycol poisoning

If you see a child or someone around you experiencing symptoms of ethylene glycol poisoning, immediately perform the following first aid:

  • Keep sources of ethylene glycol away from the patient.
  • Move the patient to a safe and comfortable place.
  • Call an ambulance.
  • Immediately check the patient's pulse and respiration.
  • Immediately start CPR if there is no pulse.
  • If the patient vomits, immediately turn the patient on his side so that vomit does not block the respiratory tract.
  • Do not induce the patient to vomit if he is not vomiting.
  • Give packaging or liquid that is suspected of being ingested by the patient to the ambulance officer.

Diagnosis of Ethylene Glycol Poisoning

Before conducting a debriefing, the doctor will first check the patient's vital signs, including level of consciousness, body temperature, pulse, respiratory rate, and blood pressure.

Furthermore, the doctor will stabilize the patient's condition by installing oxygen and breathing apparatus, infusion, urinary catheter , and feeding tube (nasogatric tube ).

After the patient's condition is stable, the doctor will ask questions and answers to the person who accompanied the patient about when the symptoms occurred and whether the patient ingested certain substances. If it is known that the patient has ingested a substance, the doctor will ask about the type of substance ingested, when the substance was ingested, and how much of the substance was ingested.

To confirm the diagnosis, the doctor will carry out further tests, such as:

  • Blood tests in the form of a complete blood count, blood gas analysis, and blood electrolytes, to determine blood calcium levels, signs of acidosis, and signs of kidney failure
  • Urine test , to determine the presence of calcium oxalate in the urine
  • Scanning with an MRI or CT scan , to detect if there are abnormalities in the nerves, although this is very rarely done

Treatment of Ethylene Glycol Poisoning

Treatment of ethylene glycol poisoning can only be done by doctors and medical personnel. After the patient is taken to the hospital, the doctor will install a breathing tube by means of endotracheal intubation .

Furthermore, the doctor will monitor the patient's condition and provide the following treatment:

  • Fluid infusion
    . The doctor will give you an infusion of sodium bicarbonate solution. This fluid infusion is performed to treat severe metabolic acidosis.
  • Ethylene glycol antidote
    There are two types of ethylene glycol antidote, namely fomepizole and ethanol. Both of these drugs are given to inhibit the formation of glycolic acid. However, ethanol is less frequently used as an ethylene glycol antidote.
  • Dialysis or hemodialysis
    In severe cases, dialysis may be performed to wash away the ethylene glycol and other toxic substances in the blood. Dialysis can also be done if the patient with ethylene glycol poisoning has kidney failure.

Complications of Ethylene Glycol Poisoning

If not treated immediately, ethylene glycol poisoning can cause the following complications:

  • Brain damage
  • Eye damage
  • Kidney failure
  • Hypovolemic shock
  • Coma
  • Dead

Prevention of Ethylene Glycol Poisoning

The main prevention of ethylene glycol poisoning is not to swallow liquids containing ethylene glycol. The Ministry of Health of the Republic of Indonesia and BPOM are also urging the public not to consume children's syrup which has been studied to contain ethylene glycol.

Other preventive measures to avoid ethylene glycol poisoning are:

  • Use personal protective equipment (PPE) in accordance with standard operating procedures (SOP) when working in an industry that uses ethylene glycol.
  • Be careful when storing household products out of reach of children.
  • Always wash your hands after using household products.
  • Do not consume alcoholic beverages that are made illegally
  • Consult a doctor if you experience symptoms of a mental disorder, such as depression , or have suicidal thoughts .
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