L7. Ethylene Glycol

Question 1

Ethylene Glycol:

overview

Answer 1

There are 100’s of household and commercial products available at home

Most cases involve accidental or misuse of home products

Most common routes of exposures are either oral or a combination or oral / dermal

94% of cases involve dogs and cats

Question 2

Ethylene Glycol:

Common locations

Answer 2

Workshops/ garage - automotive

Garden/landscaping - pesticides, fertilizers

Kitchen / bathroom - home care products

Bath/Laundry - cleaning, disinfection

Kitchen - foods, herbals

Medicine cabinet / bathroom - medications

Question 3

Critical Information Needed

Answer 3

Full trade name of the product - bring in the container

Ingredient lists: both active and inert

Amount of exposure of the product the animal contacted

Clinical signs and progression in relation to time of exposure

Treatments given by the owner … if any

Question 4

Ethylene Glycol:

Sources

Answer 4

Seasonal incidence: highest at times of use (fall/winter)

Dogs/cats most often poisoned, but all susceptible

High death rate >75%

Is used as as malicious poison - sweet taste

Question 5

Ethylene Glycol:

Toxicity

Answer 5

• Cats:
  
  • 1.5 ml EG/kg = 5.45 ml for 8lbs cat
  • oxalic acid
• Dogs
  
  • 4.6 ml EG/kg
  • 9.5 ml EG/kg → death in as little as 12 hrs
• Cattle
  
  • 6-10 ml/kg lethal

Question 6

Ethylene Glycol:

Mechanism

Answer 6

1. Absorbed intact
   
   1. peak blood levels in 1-4 hrs
   2. Initially mild CNS depression
2. Rapidly metabolized by liver enzyme alcohol dehydrogenase to:
   
   1. toxic organic acids → acidosis
   2. Hypocalcemia
   3. Calcium oxalate cyrstals in kidney

Question 7

Ethylene Glycol:

Clinical signs

Answer 7

• Acute 1st stage: 30 min - 12 hrs
  
  • vomiting, ataxia, depression, PU/PD
  • Inebriation
• 2nd stage: 12-24-72 hrs
  
  • Severe depression (acidosis)
  • Vomiting, dehydration
  • Oliguria with isosthenuria; miosis, coma
  • occasional siezures due to hypocalcemia
• 3rd stage:
  
  • oliguric renal fialure, acidosis, uremia

Question 8

Ethylene Glycol:

Diagnosis

Answer 8

• CBC:
  
  • dehydration: increased PCV, increased Serum Protein
  • stress leukogram: neutrophilia, and lymphopenia
• DX:
  
  • serum hyperosmolarity, large anion gap
  • Hyperglycemia, hyperkalemia, hypocalcemia
  • Elevated BUN, creatinine, phosphorus
  • Low urine specific gravity

Question 9

Ethylene Glycol:

Treatment

Answer 9

• Reduce further absorption
  
  • emetics, activated charcoal, cathartics within 1-2 hrs
• increase excretion, correct dehydration - IV fluids,
• Combat acidosis - Na bicarb
• Block EG metabolism, alcohol dehydrogenase start within 1-2 hrs after ingestion
• 4-MP available as Antixol-Vet
• Ethanol used in the past but can cause respiratory depression, Competitive inhibitor of ADH
• Hemodialysis