Ethylene glycol poisoning
Ethylene glycol (glycol, monoethylene glycol) is the simplest polyhydric alcohol, a colorless, oily, low-volatile liquid with an indistinct odor and a sweetish taste. It dissolves well in water, alcohol, acetone in any quantity.
Source: depositphotos.com
Ethylene glycol belongs to the class of flammable substances, spontaneous combustion occurs at a temperature of 120 ºС.
Low cost and a number of unique characteristics (including the ability to lower the freezing point of an aqueous solution) explain its widespread use in various industrial sectors:
- as part of antifreeze and brake fluids for cars;
- in cooling systems and coolants of various technically complex devices;
- in the process of manufacturing polyurethanes, synthetic plastics;
- as a cryoprotectant;
- as part of cleaning and detergents;
- as a solvent in paints and varnishes, metallurgy, printing, in the production of cosmetics, textile, leather, tobacco, pharmaceutical, perfumery, etc.
How does ethylene glycol poisoning occur?
Due to the wide industrial use of ethylene glycol, poisoning is often of a professional nature.
Acute intoxication by inhalation of vapors, mists, concentrated aerosols of ethylene glycol is unlikely, since it is not highly volatile. Chronic occupational intoxication is more likely, developing in a number of cases:
- non-observance of safety measures at the workplace;
- neglect of personal protective equipment (respirator, gloves, protective clothing);
- violations of the technological process.
Poisoning is possible when a concentrated solution is applied to the skin.
However, most often acute intoxication occurs when ethylene glycol is ingested: both deliberately, for the purpose of intoxication, and accidentally, in the form of ethanol counterfeit.
Perhaps the use of glycolic liquids for suicidal purposes, as well as children while playing.
Once in the body, ethylene glycol is oxidized to form oxalic and glyoxylic acids - metabolites with a pronounced toxic effect.
Oxalic acid, interacting with ionized blood calcium, forms crystalline oxalic calcium, which is deposited in various organs and tissues, mainly in the kidneys. As a result of the effect of ethylene glycol metabolites on the smallest structural elements of the kidney, acute necrosis and tissue edema develops with the deposition of oxalate crystals in the lumen of the tubules. Also, calcium oxalate accumulates in the tissues of the lungs, brain, pancreas, heart, liver.
The lethal dose of ethylene glycol is approximately 2 ml / kg (on average about 100 ml) for an adult, although there have been cases of fatalities when ingestion of 30-50 ml of the substance.
Poisoning symptoms
The toxic effect of ethylene glycol is manifested 2–12 hours after its use. Depending on the amount of the substance taken, intoxication of various degrees of severity develops.
Light poisoning
Manifestations:
- headache, dizziness;
- dyspnea;
- state of intoxication, similar to alcoholic (impaired speech, coordination, speech and motor excitement);
- back pain and epigastric pain;
- nausea, vomiting, diarrhea.
Objectively: deafness of heart sounds, decrease in pulse rate. When pressure is applied to the bladder, discomfort occurs.
Poisoning of moderate severity
Join:
- unsteadiness of gait;
- decreased visual acuity;
- double vision;
- oppression of consciousness.
Objectively: the pulse quickens, the blood pressure rises (blood pressure). The symptoms of kidney damage are increasing: soreness when tapping in the lumbar region, decreased urination.
Severe poisoning
The signs are:
- loss of consciousness;
- generalized cyanosis;
- sweetish odor from the mouth;
- shallow unproductive breathing;
- threadlike pulse, possibly arrhythmic;
- decrease in body temperature;
- clonic and tonic convulsions;
- involuntary urination and defecation.
Against the background of severe acute intoxication, early death (1-2 days) from a coma of central origin is possible due to damage to the vital centers of the brain.
Source: depositphotos.com
First aid for ethylene glycol poisoning
- Abundant (8-10 l) gastric lavage with warm water or 2% sodium bicarbonate solution (1 tsp of soda in a 200 ml glass of water) to clean wash water.
- Reception of enterosorbent (Enterosgel, Polysorb, Polyphepan, Atoxil or Activated carbon).
- Taking a saline laxative (magnesium sulfate).
- Abundant alkaline drink - still mineral water, milk.
- Reception as an antidote 96% ethyl alcohol at a dose of 1 ml / kg, diluted with water 2 times, or 100 ml of vodka with repeated intake after 2 hours.
When is medical attention required?
If acute ethylene glycol poisoning is suspected in all cases, it is necessary to urgently hospitalize the victim, since it is not possible to independently assess the severity of the developed condition. Since ethylene glycol metabolites can cause severe complications, including delayed ones, the victim should be in a specialized hospital under round-the-clock medical supervision.
Possible consequences
By the end of the third week of acute intoxication, up to 40% of victims die, more often from the consequences of damage to the urinary system (acute renal failure, uremic coma, azotemia).
In addition to kidney damage, the victims are diagnosed with cerebral edema, toxic liver damage, pulmonary edema, fluid and punctate hemorrhages in the tissues of the heart bag, and inflammatory changes in the myocardium. A rare complication is bilateral optic nerve atrophy.
Prevention
- Compliance with safety measures when working in production where ethylene glycol is involved.
- Use of personal protective equipment in direct contact with the toxin (goggles and clothing, respirator, gloves).
- It is unacceptable to purchase alcoholic beverages "off hand" at deliberately low prices, in the absence of an excise stamp, in substandard containers.
- Keep liquids containing ethylene glycol out of the reach of children.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
