Polyethylene glycol intoxication in burn patients

Area of Science:

• Toxicology
• Nephrology
• Burn Care

Background:

• Burn patients treated with polyethylene glycol (PEG)-based creams exhibited unexplained metabolic abnormalities.
• Exclusion of other causes pointed towards toxicity from the topical PEG formulation.

Purpose of the Study:

• To investigate the cause of unexplained anion gap and osmolality increases in burn patients treated with PEG-based burn cream.
• To identify the toxic agent and understand the associated metabolic derangements.

Main Methods:

• Clinical observation of three fatal cases.
• Laboratory analysis of serum electrolytes, osmolality, and identification of circulating toxins.
• Comparison of findings with known ethylene glycol poisoning and experimental data in rabbits.

Main Results:

• Patients presented with metabolic acidosis, increased anion gap, and elevated serum osmolality.
• Ethylene glycol was detected in circulation, and all patients developed acute renal failure.
• A unique 'calcium gap' (increased total serum calcium with decreased ionized calcium) was observed, attributed to calcium binding by PEG metabolites.

Conclusions:

• Absorption of polyethylene glycol from burn cream can cause severe toxicity, including acute renal failure and metabolic acidosis.
• PEG-induced toxicity shares features with ethylene glycol poisoning but is distinguished by a significant calcium imbalance.
• Dicarboxylic acid metabolites of PEG appear to bind calcium, leading to the observed 'calcium gap'.