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Antifreeze (ethylene glycol) intoxications in Baltimore. Report of six cases
1Dept. of Pathology, University of Maryland.
Abstract:
Records of the Office of the Chief Medical Examiner (OCME) for the State of Maryland were reviewed for all deaths related to acute ingestion of antifreeze (ethylene glycol [EG]) occurring between December 1985 and December 1987. Six cases were identified. In three cases, the manner of death was classified as undetermined, in two suicide, and in one case the intoxication was considered to have contributed to death, but was not the main cause. Clinically, the hospitalized subjects exhibited primary metabolic acidosis with hypocalcemia, hyperglycemia, and an elevated anion and osmolar gap. At autopsy, the findings related to EG ingestion were typical of a non-specific drug intoxication. Histological examinations in five cases demonstrated the presence of calcium oxalate crystals in the renal tubules; in three cases extensive renal tubular necrosis appeared related to the survival time. The toxicological analysis in three cases revealed lethal EG levels in the blood.
Insights
Acute antifreeze (ethylene glycol) ingestion caused severe metabolic acidosis and kidney damage. Fatalities were linked to suicide or undetermined causes, highlighting the dangers of ethylene glycol poisoning.
Area of Science:
- Forensic Pathology
- Toxicology
- Nephrology
Background:
- Review of Maryland Office of the Chief Medical Examiner records (1985-1987).
- Focus on deaths due to acute antifreeze (ethylene glycol) ingestion.
- Identification of six fatal cases.
Observation:
- Clinical presentation included metabolic acidosis, hypocalcemia, hyperglycemia, and elevated osmolar/anion gaps.
- Autopsy findings were consistent with non-specific drug intoxication.
- Histological examination revealed calcium oxalate crystals and renal tubular necrosis in multiple cases.
Findings:
- Three deaths classified as undetermined, two as suicide, and one where intoxication contributed to death.
- Toxicological analysis confirmed lethal ethylene glycol levels in three cases.
- Renal tubular necrosis correlated with patient survival time.
Implications:
- Ethylene glycol poisoning presents with distinct metabolic and renal disturbances.
- The presence of calcium oxalate crystals is a key diagnostic indicator.
- Understanding these patterns aids in forensic and clinical management of antifreeze ingestion cases.