Diethylene glycol poisoning

@article{Schep2009DiethyleneGP,
  title={Diethylene glycol poisoning},
  author={Leo J. Schep and Robin J Slaughter and Wayne A. Temple and D Michael G Beasley},
  journal={Clinical Toxicology},
  year={2009},
  volume={47},
  pages={525 - 535}
}
Introduction. Diethylene glycol (DEG) is a clear, colorless, practically odorless, viscous, hygroscopic liquid with a sweetish taste. In addition to its use in a wide range of industrial products, it has also been involved in a number of prominent mass poisonings spanning back to 1937. Despite DEG's toxicity and associated epidemics of fatal poisonings, a comprehensive review has not been published. Methods. A summary of the literature on DEG was compiled by systematically searching OVID… 

Identification and quantification of diethylene glycol in pharmaceuticals implicated in poisoning epidemics: an historical laboratory perspective.

The historical approach to identifying and quantifying DEG during each of these outbreaks is described, which includes the development of biomarkers of DEG exposure, which would be extremely useful in instances where pharmaceuticals are not clearly implicated.

Antidotes for poisoning by alcohols that form toxic metabolites.

Fomepizole has largely replaced ethanol as the toxic alcohol antidote in many countries, Nevertheless, ethanol remains an important alternative because access to fome pizole can be limited, the cost may appear excessive, or the physician may prefer ethanol due to experience.

Diethylene Glycol in Health Products Sold Over-the-Counter and Imported from Asian Countries

Based on current standards, these levels probably do not represent an acute public health threat and additional research focusing on why DEG is found in these products and on the minimum amount of DEG needed to result in toxicity is needed.

Management of diethylene glycol ingestion

The management dilemma in this case was whether to initiate fomepizole therapy, administer hemodialysis, or both given the high risk circumstances of the presentation, which highlights the difficulty regarding management of these cases while attempting to balance resource utilization, diagnosis, monitoring, and therapy.

Neurological Manifestation of Recreational Fatal and Near-Fatal Diethylene Glycol Poisonings

Three cases of recreational diethylene glycol poisoning seen in Hamad General Hospital, Doha, Qatar from 2009 to 2012 are detailed here, with emphasis on the neurological sequelae that include encephalopathy and multiple cranial and peripheral neuropathies with fatal and near-fatal outcomes.

Diagnosis of toxic alcohols: limitations of present methods

Developing more rapid and effective tests for detection of these intoxications is essential for optimal care of patients and to examine the value and limitations of present methods to diagnose patients with possible toxic alcohol exposure.

Inhibition of metabolism of diethylene glycol prevents target organ toxicity in rats.

The results indicate that the mechanism for the target organ toxicity results from metabolites of DEG, and not DEG itself nor formation of EG from DEg, and that fomepizole may be a useful antidote for treating DEG poisoning.

Fatal poisoning with diethylene glycol in an unusual setting

The present case describes an unusual example of a single decedent who drank clear fluid from a tequila bottle that was given to him by a friend and died eight days later, due to fatal intoxication by diethylene glycol (DEG).
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References

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Identification and quantification of diethylene glycol in pharmaceuticals implicated in poisoning epidemics: an historical laboratory perspective.

The historical approach to identifying and quantifying DEG during each of these outbreaks is described, which includes the development of biomarkers of DEG exposure, which would be extremely useful in instances where pharmaceuticals are not clearly implicated.

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It has been suggested by the American investigators of this disaster that suiphanilamide and diethylene glycol may produce additive toxic actions when given in combination.

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In acute DEG poisoning, both the mechanism and the treatment appear to be the same as in acute EG intoxication, and the ability of ethanol infusions to prevent hepatic oxidation of DEG has not been proved.

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A series of seven patients presenting with epidemic DEG poisoning from a correctional facility with varying degrees of metabolic acidemia and acute renal impairment responding to emergent hemodialysis (HD) develop delayed neurologic toxicity which has not been well characterized in the past.

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Fomepizole has clear advantages over ethanol in terms of validated efficacy, predictable pharmacokinetics, ease of administration, and lack of adverse effects, whereas ethanol hasclear advantages over fome pizole in Terms of long-term clinical experience and acquisition cost.

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The pancreatic, central and peripheral nervous system lesions as well as the glomerular arteriolar hyalinosis have not been previously described in the literature in relation with diethylene glycol poisoning.

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A young female suicidally ingested DEG and TEG was presented in metabolic acidosis with coma, given 4-methylpyrazole (4-MP), an ADH inhibitor, the acidosis resolved, the patient recovered and was discharged without sequelae.
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