Abstract
Background
Diethylene glycol (DEG) is an industrial solvent with many uses, including brake fluids.
It has also caused mass poisonings after use as an inappropriate substitute for propylene
glycol or glycerin, though individual ingestions are rare. Like other toxic alcohols,
DEG is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase, with toxicity
likely mediated by the resulting metabolites. Fomepizole, an alcohol dehydrogenase
inhibitor, is used to prevent metabolite formation with other toxic alcohol exposures.
Fomepizole is recommended for DEG poisoning, though supporting clinical evidence is
limited.
Case Report
A 31-year-old man presented after ingestion of DEG-containing brake fluid and hydrocarbon-containing
“octane booster.” He was noted to be clinically intoxicated, with a mildly elevated
anion gap metabolic acidosis and no osmolar gap. DEG level was later found to be elevated,
consistent with his ingestion. He was treated with fomepizole alone, with resolution
of metabolic acidosis and clinical findings over the next 2 days. No delayed neurologic
sequelae were present at 52-day follow-up. Our case provides additional evidence supporting
the use of fomepizole for DEG poisoning. Consistent with other toxic alcohols, DEG
poisoning, especially early presentations, may benefit from empiric fomepizole administration.
Why Should an Emergency Physician Be Aware of This?
DEG poisoning is potentially life threatening, but treatable if identified early.
An ingestion can be toxic despite a normal osmolar gap, leading to false reassurance.
Finally, it is rare, so emergency physicians must be made aware of its potential dangers.
Keywords
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References
- Diethylene glycol poisoning.Clin Toxicol (Phila). 2009; 47: 525-535
- Diethylene glycol: widely used solvent presents serious poisoning potential.J Emerg Med. 2008; 35: 401-406
- Toxic alcohol ingestions: clinical features, diagnosis, and management.Clin J Am Soc Nephrol. 2008; 3: 208-225
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- Intravenous 4-methylpyrazole as an antidote for diethylene glycol and triethylene glycol poisoning: a case report.Vet Hum Toxicol. 1997; 39: 26-28
Article info
Publication history
Published online: April 29, 2022
Accepted:
April 23,
2022
Received in revised form:
March 21,
2022
Received:
December 10,
2021
Footnotes
Presentations: Presented at the American College of Medical Toxicology Annual Scientific Meeting (March, 2022).
Identification
Copyright
© 2022 Published by Elsevier Inc.
