Repeated ingestion of 2-butoxyethanol: case report and literature review

Ethylene glycol monobutyl ether (2-butoxyethanol) is not commonly associated with significant human poisoning. Exposures are usually through occupational contact and typically involve inhalation injury. Animal studies report severe hemolysis occurring in rats and mice. Rare published human cases give varied descriptions of the clinical course associated with 2-butoxyethanol poisoning including reports of metabolic acidosis, ethylene glycol production, oxaluria, renal failure, and anemia. We report a case of two separate ingestions (80 to 100 grams) of a glass cleaner concentrate containing 22% 2-butoxyethanol, and its primary metabolite butoxyacetic acid.

An 18-year-old male ingested 360-480 mL of 22% 2-butoxyethanol on two separate occasions. Approximately 10hours after the first ingestion, the patient developed severe CNS depression, metabolic acidosis, hematuria, and mild elevation of hepatic enzymes. He was treated initially with ethanol therapy but continued to deteriorate and was started on hemodialysis. Approximately 10 days after discharge, the patient ingested 480 mL of the same product and received ethanol and hemodialysis within four hours of ingestion. During his second admission the patient did not develop the delayed severe CNS depression or profound metabolic acidosis. Clinically significant hemolytic anemia, oxaluria, ethylene glycol production, and renal failure were not noted in either episode. The patient recovered on both occasions without sequelae.

Hemodialysis may be an effective treatment intervention for managing severe acute 2-butoxyethanol intoxication, however, further investigation is warranted.