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Toxicology Fall17 > Ethylene Glycol > Flashcards

Ethylene Glycol Flashcards

1
Q

What is the best treatment for ethylene glycol toxicosis?

A

Fomepazole (4-MP)

**it will NOT created a false positive when testing for ethylene glycol

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2
Q

What is the most common route of exposure of ethylene glycol?

A

Ingestion

  • *has a sweet taste
  • low molecular weight - activated charcoal does not work well
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3
Q

What is the mortality rate reported for ethylene glycol toxicosis in dogs and cats?

A

59-70%

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4
Q

What is the minimal lethal does of antifreeze in dogs and cats?

A

Dogs: 4.2 - 6.6 ml/kg
Cats: 1.4 ml/kg

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5
Q

How is antifreeze absorbed?

A

Readily absorbed in the GIT

absorption will be delayed by food

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6
Q

What is the half life of antifreeze?

A

3-4 hours in dogs
shorter in cats

Dog - peak plasma level at 2 hours

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7
Q

What synthesis does antifreeze undergo in the liver?

A

Lethal synthesis

E.G. is oxidized to glycoaldehyde

Glycoaldehyde is oxidized to glycolic acid

Glycolid acid is oxidized GyloXylic acid—> TONS of other acids are made after this

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8
Q

What crystals are created from Oxalic acid and calcium binding due to the ingestion and absorption of antifreeze?

A

Insoluble calcium oxalate monohydrate crystals

form in the tissues - causing damage and passed in the uring

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9
Q

How long are the metabolites of ethylene glycol present for?

A

Several days

a small amount of ethylene glycol will be excreted in the urine unchanged (within 24 hrs)

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10
Q

What side effect do calcium oxalate monohydrate crystals have?

A

Hypocalcemia

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11
Q

What are the main toxic effects of the metabolites of ethylene glycol?

A

Metabolic acidosis and acute renal failure

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12
Q

What toxic effects does ethylene glycol itself, have on the body?

A

Direct GI irritation
increased serum osmolality = osmotic diuresis
CNS depression

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13
Q

What CNS effects does ethylene glycol have?

A

CNS dysfunction resulting in inhibition of respiration, dysfunction of: glucose and serotonin metabolism, alteration of amine concentration

marked cerebral edema in later stages

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14
Q

What are the early clinical signs noted in patients with ethylene glycol toxicosis ? (30min to 12 hours post ingestion)

A

DOG: nausea, vomiting, anorexia, CNS depression, ataxia, incoordination, hypothermia, PUPU, dehydration, tachycardia/pnea… death

*CATS: are markedly depressed and usually do not show polydipsia

**these signs are associated with EG and systemic acidosis

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15
Q

What are the late clinical signs noted in patients with ethylene glycol toxicosis ? (12 - 24 hours post ingestion)

A

Animals that survive early stage will develop oliguric renal failure

vomiting, anorexia, depression, severe lethargy, coma, seizures, oliguria, and renal pain

Anuria (72-96 hours post ingestion)

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16
Q

Clinical stages of EG toxicosis are shorter or longer in the cat when compared to the dog?

A

Stages are shorter in duration in cats

*early signs might not be noticed by owners

17
Q

At what point in EG toxicosis does the prognosis really drop off?

A

Once renal signs develop.. they are not reversible

best prognosis is for patients who present and start treatment prior to development of renal failure

18
Q

What lesions are characteristic of EG toxicosis?

A

HGE, pulmonary edema, pale and swollen kidneys with grey or yellow streaks

19
Q

Where might calcium oxalate monohydrate crystals be found in a patient with EG poisoning?

A

in the kidney, urine. perivascular spaces in the brain

20
Q

Anion gaps of more than ______ mEq/L are typical of EG

A

40-50

normal is 10-27 mEq/L

21
Q

How soon after EG ingestion may you see an increased anion gap?

A

3-6 hours post ingestion

this will stay increased for about 48 hours

22
Q

What laboratory changes will be noted in patients with EG poisoning?

A 
Metabolic acidosis
LOW urine specific gravity (w/in 3hr PI)
hypocalcemia (~50% of p)
hyperglycemia (~50% of p)
Acute renal failure changes: elevated Creat/BUN, Hyperphosphatemia (this may rise very early 3-6hr PI), hyperkalemia

increased PCV/TP

23
Q

What is the goal or MOA of EG antidotes?

A

To stop and prevent the lethal synthesis of ethylene glycol - so it will just be slowly excreted unchanged in the urine (since the acid metabolites will cause the most severe and irreversible damage)

24
Q

What is the time frame of peak EG concentration in blood?

A

1-6 hours post ingestion

best time to test blood, urine, renal tissue

25
Q

What are the 2 antidote treatment options for ethylene glycol toxicosis?

A

Fomepizole and Ethanol 20%

26
Q

What are the advantages to Fomepizole treatment over using 20% Ethanol?

A
  1. NO CNS depression, diuresis, or hyperosmolality
  2. Will not create any false positives with EG tests
  3. Faster recover time
27
Q

What is the downside to Fomepizole treatment?

A

SUPER EXPENSIVE

28
Q

Ideally, at what time after formepizole treatment would you check EG blood levels?

A

36 hour mark

Tx is admin asap at dx, 12 hr, 24 hr, and 36 hr post ingestion

29
Q

What are the negative side effects of Ethanol treatment? What is the MOA?

A

Ethanol is used as a competitive inhibitor for alcohol dehydrogenase (so no lethal synthesis will occur)

Causes CNS depression (animals are getting drunk) and increased blood osmolality - leads to diuresis. Patients need to be on IVF at the same time

30
Q

T/F: Activated charcoal is recommended as a detox protocol for EG poisoning

A

FALSE

EG particles are too small to be effectively adsorbed by activated charcoal

31
Q

What is the prognosis for EG poisoning in patients that are azotemic at diagnosis?

A

GRAVE

32
Q

What is the prognosis for EG poisoning in patients that start early treatment?

A

Good prognosis if tx is started within 5-6 hours for dogs and within 3 hours for cats

33
Q

Will fomepazole cause a false positive result on the Kacey EG test?

A

NO

will not cause any false positives on any EG test

34
Q

Will ethanol cause a false positive result on the Catachem EG test?

A

NO

but propalyene glycol can on the qualitative portion - NOT the quantitative

35
Q

Will ethanol cause a false positive result on the Kacey EG test?

A

YES

36
Q

What is the window of opportunity for EG testing using the Kacey EG test?

A

30 mins - 14 hours post ingestion

Run on plasma only

37
Q

T/F: A negative EG test result will always rule out EG poisoning

A

FALSE

EG may be in the secondary phase where EG presence is low and toxic metabolites are high

Toxicology Fall17 (38 decks)

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