ETHYLENE GLYCOL INTOXICATION 71110 PY MINDMAPS RELATIVELY NONTOXIC

15A NCAC 02D 0538 CONTROL OF ETHYLENE OXIDE EMISSIONS
DESIGNING AN ETHYLENE PLANT CONTROL ROOM AND OPERATOR USER
ETHYLENE GLYCOL INTOXICATION 71110 PY MINDMAPS RELATIVELY NONTOXIC

ETHYLENE OXIDE PHYSICALCHEMICAL CHARACTERISTICS EO IS CARCINOGENIC FOR HUMANS
ETHYLENE PRODUCTION SENSITIVITY CHART RECOMMENDED ETHYLENE SENSITIVITY TEMPERATURE
FTORPLAST™ ETFE GRANULATED ETHYLENE TETRAFLUOROETHYLENE COPOLYMER CHEMICAL NAME

Ethylene Glycol Intoxication

Ethylene Glycol Intoxication



7/11/10

PY Mindmaps



- relatively non-toxic -> metabolites extremely toxic (glycolate)

- rate limiting step = alcohol dehydrogenase activity

- accumulation of glycolate -> direct cellular toxicity



CLINICAL FEATURES


- drunk: automotive antifreeze, solvent, polish, paints, cosmetics, brake fluid, car wash fluid.


- 30 minutes -> 12 hours post ingestion:excitement, confusion, disorientation -> ataxia, lethargy, stupor, coma, nausea/vomiting, myoclonus, seizures, cranial nerve deficits: nystagmus, ophthalmoplegia, facial palsy, dysarthria, dysphagia

- 12 – 24 hours: progressive cardiorespiratory failure

- 24 – 72 hours: renal failure from ATN


- toxic dose = 1.5mL/kg of 95% ethylene glycol



INVESTIGATIONS


- ethylene glycol level

- severe metabolic acidosis (high anion gap) from glycolic acid accumulation

- very high lactate (artefactual as there is high cross reactivity between lactate and glycolate in laboratory analysis) -> high lactate with oxidase method, less high with lactate dehydrogenase method

- high osmolar gap

- calcium oxalate crystalluria (oxalate produced by ethylene glycol metabolism chelates Ca2+ -> formation of crystals) + hypocalcaemia

- fluorescence of urine on exposure to UV light (automotive antifreeze solutions have this to identify cooling system leaks)



MANAGEMENT


- goal = blockade of alcohol dehydrogenase -> so ethylene glycol isn’t converted to glycolate


- decrease absorption: no techniques really effective

- decrease production of toxic metabolites: ethanol or 4-methylpyrazole (not easily available in Australiasia)


-> ethanol dose (IV): 10% solution in D5W as a 40% solution, loading dose 7.5mL/kg -> 1-2mL/kg/hr

-> ethanol dose (PO): quarter the above dose

-> dose in CRRT: double IV dose

-> maintain ethanol level @ 25-40mmol/L


- haemodialysis

- thamine 100mg IV Q6 hrly – theoretical benefit to increase elimination

- pyridoxine (vitamin B6) 50mg IV Q6hrly – theoretical benefit to increase elimination

- don’t replace Ca2+ unless low enough to cause manifestations

Jeremy Fernando (2011)


HTTPSTAFFTUHSDK12AZUSGFOSTERSTANDARDBGRAPH6HTM GRAPHING PRACTICE PROBLEM 1 AMOUNT OF ETHYLENE IN
LOW VELOCITY IMPACT ON LAMINATES REINFORCED WITH POLYETHYLENE AND
MONARFLEX RAC GAS MEMBRANE 140A LOOSE LAID POLYETHYLENE GAS


Tags: mindmaps, ethylene, relatively, glycol, nontoxic, intoxication, 71110