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Diethylene glycol poisoning and liver function following accidental diethylene glycol injection.

ABSTRACT: The aim of the present study was to investigate the hepatotoxic effects of accidental intravenous diethylene glycol (DEG) poisoning in patients with liver disease. Clinical manifestations were recorded and liver function tests were carried out for 64 patients with liver disease who had been accidentally treated intravenously with DEG. Comparisons were made between the poisoned and non-poisoned groups. Of the 64 cases with preexisting liver disease, 15 cases (23.4 %) developed toxic presentations after exposure to DEG. All cases were men. Twelve of the 15 poisoned patients (80 %) died within seven days. The intravenous administration of DEG resulted in only mild liver function impairment. Gender (p = 0.039) and the severity of jaundice prior to DEG administration were risk factors related to the occurrence of toxin-induced renal failure (p < 0.006). The results suggest that DEG may worsen liver damage in patients with preexisting liver disease. However, our study demonstrated only mild, transient alterations in patients' baseline liver functions. Severe liver damage secondary to DEG was only occasionally seen in patients with concomitant renal failure.

SUBMITTER: Lin CS

PROVIDER: S-EPMC4920036 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Diethylene glycol poisoning and liver function following accidental diethylene glycol injection.

Lin Chao-Shuang CS Cai Qing-Xian QX Huang Zhan-Lian ZL Lin Bing-Liang BL Chong Yu-Tian YT Zhao Zhi-Xin ZX Gao Zhi-Liang ZL

EXCLI journal 20120320

The aim of the present study was to investigate the hepatotoxic effects of accidental intravenous diethylene glycol (DEG) poisoning in patients with liver disease. Clinical manifestations were recorded and liver function tests were carried out for 64 patients with liver disease who had been accidentally treated intravenously with DEG. Comparisons were made between the poisoned and non-poisoned groups. Of the 64 cases with preexisting liver disease, 15 cases (23.4 %) developed toxic presentations ...[more]

PMID: 27350772

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Project description:Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid-base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong ("we recommend") or weak/conditional ("we suggest"), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8-12 mmol/L or anion gap 23-27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.

Dataset Information

Diethylene glycol poisoning and liver function following accidental diethylene glycol injection.

Publications

Diethylene glycol poisoning and liver function following accidental diethylene glycol injection.

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