Ethylene glycol poisoning

What it is

From: Orphanet

A rare poisoning resulting in elevated anion gap metabolic acidosis, due to the production of glycolic acid, glyoxylic acid, and oxalic acid by alcohol dehydrogenase (ADH) in the liver when ethylene glycol is metabolized, characterized initially by euphoria, slurred speech, encephalopathy, coma and seizures, and followed by late manifestations such as tachycardia, arrhythmias, myocardial depression, hemodynamic imbalance and, finally, acute renal failure.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Lactic acidosis · Very frequent (99-80%)

An abnormal buildup of lactic acid in the body, leading to acidification of the blood and other bodily fluids.

Metabolic acidosis · Very frequent (99-80%)

Metabolic acidosis (MA) is characterized by a fall in blood pH due to a reduction of serum bicarbonate concentration. This can occur as a result of either the accumulation of acids (high anion gap MA) or the loss of bicarbonate from the gastrointestinal tract or the kidney (hyperchloremic MA). By definition, MA is not due to a respirary cause.

Ataxia · Frequent (79-30%)

Ataxia refers to impaired coordination of voluntary muscle movement. Cerebellar ataxia refers to ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits including asynergy (lack of coordination between muscles, limbs and joints), dysmetria (lack of ability to judge distances that can lead to under- or overshoot in grasping movements), and dysdiadochokinesia (inability to perform rapid movements requiring antagonizing muscle groups to be switched on and off repeatedly).

Confusion · Frequent (79-30%)

Lack of clarity and coherence of thought, perception, understanding, or action.

Drowsiness · Frequent (79-30%)

Abnormal feeling of sleepiness or difficulty staying awake.

Elevated serum anion gap · Frequent (79-30%)

An abnormally high value of the serum anion gap (the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration).

Euphoria · Frequent (79-30%)

Elevation of emotional tone or mood that significantly deviates from normative affective functioning. This state is characterized by an overwhelming and all-encompassing sense of joyous well-being; it is associated with unfounded grandiosity, or grossly inflated self-esteem, rapid speech, impulsivity, and an impaired capacity for self-regulation, irrespective of context.

Hypocalcemia · Frequent (79-30%)

The concentration of calcium in the blood circulation is below the lower limit of normal.

Nausea · Frequent (79-30%)

A sensation of unease in the stomach together with an urge to vomit.

Slurred speech · Frequent (79-30%)

Abnormal coordination of muscles involved in speech.

Tachycardia · Frequent (79-30%)

A rapid heartrate that exceeds the range of the normal resting heartrate for age.

Tachypnea · Frequent (79-30%)

Very rapid breathing.

Vomiting · Frequent (79-30%)

Forceful ejection of the contents of the stomach through the mouth by means of a series of involuntary spasmic contractions.

Abnormal pattern of respiration · Occasional (29-5%)

An anomaly of the rhythm or depth of breathing.

Other findings in the same source

From: Orphanet

Additional reported features include Abnormal pupillary light reflex (Occasional (29-5%)); Alcoholism (Occasional (29-5%)); Atrial fibrillation (Occasional (29-5%)); Coma (Occasional (29-5%)); Congestive heart failure (Occasional (29-5%)); Cyanosis (Occasional (29-5%)); Gastritis (Occasional (29-5%)); Headache (Occasional (29-5%)); Hyperkalemia (Occasional (29-5%)); Hypertension (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

All ages

Inheritance in the source

From: Orphanet

Not applicable

Which doctor should you see?

The suggested department for discussing Ethylene glycol poisoning is Emergency Medicine, with a emergency physician as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• What is the immediate problem that needs stabilisation?
• Which results and discharge instructions should the family keep?
• What follow-up and return precautions are needed after emergency treatment?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Ethylene glycol poisoning. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.