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Mass Poisoning From Ethylene Glycol at a U.S. Military Base
Nina Shah1, Maurice Khayat2, David Owshalimpur2
1Department of Medicine-Nephrology, William Beaumont Army Medical Center, El Paso, TX 79918, USA.
Military Medicine
|December 23, 2022
Summary
This study details an ethylene glycol (EG) poisoning outbreak among soldiers, highlighting treatment challenges with limited resources. It underscores the need for updated guidelines for managing EG toxicity in mass casualty events.
Area of Science:
- Toxicology
- Emergency Medicine
- Public Health
Background:
- Ethylene glycol (EG) poisoning is a significant cause of toxic alcohol ingestions in the USA.
- Mass poisoning outbreaks are rare but can occur, posing unique challenges to healthcare systems.
- This case describes a collective ingestion of EG among soldiers, presenting a unique public health scenario.
Purpose of the Study:
- To describe an outbreak of ethylene glycol poisoning from collective ingestion among soldiers.
- To analyze treatment strategies and outcomes in a resource-limited setting.
- To identify needs for improved guidelines in managing mass EG poisoning events.
Main Methods:
- Retrospective case series of eleven soldiers presenting with suspected ethylene glycol ingestion.
- Treatment decisions based on clinical presentation and surrogate laboratory values due to delayed serum EG levels.
- Analysis of interventions including fomepizole (FOM), hemodialysis, IV fluids, and cofactor administration.
Main Results:
- Two patients with severe symptoms received immediate hemodialysis and FOM, developing acute kidney injury with full recovery.
- Other patients received varying treatments including IV fluids and FOM, with outcomes ranging from prolonged observation to full recovery.
- All eleven soldiers survived the ethylene glycol poisoning event.
Conclusions:
- Collective ethylene glycol ingestion can overwhelm healthcare resources, especially in resource-limited communities.
- Management decisions in mass poisoning require clear guidelines for resource allocation, including dialysis and fomepizole.
- Further research is needed to optimize treatment protocols and address comorbid conditions influencing recovery from EG toxicity.
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