Management of diethylene glycol ingestion

Diethylene glycol is a toxic alcohol used as an industrial solvent in various products. Human exposure to diethylene glycol has resulted in multisystem organ dysfunction and death in cases of acute intentional ingestions as well as epidemics of mass poisoning. Debate remains as to whether the parent compound or metabolite, 2-hydroxyethoxyacetic acid, is responsible for the majority of the toxicity seen in diethylene glycol poisoning. Therefore, cases of diethylene glycol poisoning create management dilemmas when deciding whether to administer alcohol dehydrogenase inhibitors, hemodialysis, or both.

A 35-year-old male was presented to the emergency department reporting that he intentionally ingested brake fluid containing diethylene glycol 8 hours prior to arrival. The patient complained only of epigastric abdominal pain, had a normal physical exam, with a serum bicarbonate of 22 mmol/L, serum creatinine of 0.9 mg/dL, and an undetectable serum ethanol. The management dilemma in this case was whether to initiate fomepizole therapy, administer hemodialysis, or both given the high risk circumstances of the presentation. The decision was made not to administer any therapy other than usual supportive care. Serial basic metabolic panels were sent showing the development of no acidosis or renal dysfunction until his serum diethylene glycol concentration returned undetectable.

Diethylene glycol ingestion can be life threatening. This case highlights the difficulty regarding management of these cases while attempting to balance resource utilization, diagnosis, monitoring, and therapy. Due to continued debate, these decisions remain practitioner specific.