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Paediatric clinical pharmacology
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The harm caused by poisons, which must undergo metabolic processing to exert any toxic effect, can be modulated by preventing their metabolism. Treatment of ethylene glycol poisoning is based on inhibition of the enzyme alcohol dehydrogenase. Historically, treatment involved administering ethanol-utilising competitive inhibition of alcohol dehydrogenase to prevent significant metabolism of the ethylene glycol. Although elegant from a pharmacological perspective (Figure 3), ethanol can produce profound hypoglycaemia in young children and this antidote strategy was not without its risks. Fomepizole, a specific inhibitor of alcohol dehydrogenase, is now the treatment of choice (Figure 3).
Ethylene Glycol
Published in David J. George, Poisons, 2017
Ethylene glycol is a synthetic chemical that is the primary ingredient in most automotive antifreeze/coolant products and aircraft deicing fluids. Antifreeze products are easily accessible and, because ethylene glycol has a sweet taste, they can be surreptitiously added to sports drinks, alcoholic cocktails, and other beverages and foods. Homicides involving ethylene glycol are commonly detailed in news reports, which can provide the methodology for poisoning in various circumstances. Media coverage of antifreeze poisoning incidents has contributed to the incidences of intentional poisonings, whether suicidal or homicidal.
Cardiology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Simultaneous heart and renal failure:1 HTN.2 DM.3 Generalised (coronary and renovascular) atherosclerosis.4 Vasculitides (PAN, etc).5 Thrombosis (antiphospholipid syndrome).6 Emboli (infective endocarditis).7 Fibrosis (systemic sclerosis; amyloidosis).8 Ethylene glycol poisoning.
The serum glycolate concentration: its prognostic value and its correlation to surrogate markers in ethylene glycol exposures
Published in Clinical Toxicology, 2022
Darren M. Roberts, Robert S. Hoffman, Jeffrey Brent, Valéry Lavergne, Knut Erik Hovda, William H. Porter, Kenneth E. McMartin, Marc Ghannoum
Ethylene glycol is commonly used in many antifreeze products and is responsible for thousands of toxic exposures in the US from intentional self-harm and unintentional ingestions [1]. Ethylene glycol is also one of the more common indications for the use of extracorporeal treatments in clinical toxicology worldwide [2,3]. Ethylene glycol is metabolized by the enzymes alcohol dehydrogenase (ADH), aldehyde dehydrogenase, and glycolic acid oxidase into several metabolites including oxalate and glycolate which are responsible for toxic effects such as a wide anion gap acidemia, acute kidney injury (AKI), and coma. Glycolate is the ethylene glycol metabolite present in the greatest concentration in the blood [4,5] and is therefore thought to be strongly prognostic of outcomes [6–8]. Glycolate assays are unfortunately rarely available, so other biochemical surrogates may be valuable to prognosticate outcomes in ethylene glycol poisoning.
Carcinogenicity of ethylene oxide: key findings and scientific issues
Published in Toxicology Mechanisms and Methods, 2018
Jennifer Jinot, Jason M. Fritz, Suryanarayana V. Vulimiri, Nagalakshmi Keshava
Ethylene oxide (C2H4O; EtO) is a gas at room temperature. It is derived from ethylene and used primarily as a chemical intermediate in the production of ethylene glycol (for the manufacture of antifreeze and polyester fibers). EtO is also used in the derivation of numerous other chemicals (e.g. various ethoxylation products, polyethylene glycols, glycol ethers, and ethanolamines), which are employed in the production of a variety of industrial and consumer products (e.g. surfactants, detergents, solvents, plasticizers, lubricants, personal care products, and pharmaceuticals) (IARC 2008). A small proportion (<1%) of EtO is used for the sterilization of medical equipment, spices, and other items.
Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review
Published in Clinical Toxicology, 2022
Jessie Beaulieu, Darren M. Roberts, Sophie Gosselin, Robert S. Hoffman, Valery Lavergne, Knut Erik Hovda, Bruno Megarbane, Derrick Lung, Ruben Thanacoody, Marc Ghannoum
Ethylene glycol is commonly used in many antifreeze products and each year is responsible for thousands of toxic exposures worldwide from intentional self-harm and other reasons [1,2,3]. Ethylene glycol itself causes little toxicity; however, its metabolites (glycolate, glyoxylate and oxalate) induce a wide anion gap metabolic acidemia and end-organ toxicity such as acute kidney injury (AKI), coma, seizures, cranial nerve defects, and death. In fact, ethylene glycol is the leading poisoning for which extracorporeal treatments are used in several countries [4].