Ethylene Glycol Poisoning

Ethylene glycol poisoning is very dangerous. It can be fatal or cause live-long health consequences. Given the widespread use of ethylene glycol, the poisoning occurs quite often.


The cause of poisoning is ingestion of a substance called ethylene glycol. The substance has a sweet taste and it is used as an antifreeze agent in vehicles and it also has extensive use in industry. The sweet taste is a reason of accidental poisoning of children. In addition, ethylene glycol ingestion may occur in a suicide attempt.


The ethylene glycol alone is not toxic, but it is affected by our body enzymes that convert it to toxic products. The ethylene glycol is transformed by an enzyme alcohol dehydrogenase to a toxic substance glycolaldehyde, which is later converted to other toxic compounds including the oxalic acid. Knowledge of ethylene glycol biochemical behavior in the body is necessary for proper treatment.


Ethylene glycol poisoning manifests with symptoms such as headache, nausea, vomiting, confusion, loss of consciousness, arrhythmias and sometimes even death. The oxalic acid (final product of ethylene glycol) gives rise to crystals in kidneys that may cause an acute kidney failure.


Ethylene glycol-containing liquids should have their bottles clearly marked. As the ethylene glycol has a sweet taste, it is sometimes mixed with other substances making it bitter to decrease the chance of a child accidental poisoning.


For the treatment we use our biochemical knowledge. The above-mentioned enzyme alcohol dehydrogenase also chemically processes the alcohol (chemically ethanol). The enzyme converts ethanol to acetalaldehyde (which is responsible for the hangover) and another enzyme transforms the acetalaldehyde to a harmless acetic acid.


Furthermore, the alcohol dehydrogenase has a bigger affinity to ethanol than to ethylene glycol. Simply put, if the enzyme has enough ethanol molecules nearby, it will convert them and the ethylene glycol molecules have to wait.


Therefore, the basic therapeutic option is and administration of alcohol. As first aid, it is possible to use any hard liquor and in hospitals, there is possibility to use special alcohol solutions for intravenous use. The desired serum level of alcohol, which should protect the patient, is 1 per mille. The ethylene glycol molecules have to wait and they are gradually eliminated from the body in an unconverted form.


In a very serious acute condition, it is possible to use dialysis to remove the toxic products from the blood and to support the kidney that may be damaged by the poison.


Note: As you may notice, the treatment of ethylene glycol poisoning is similar to the approach in methanol poisoning.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources