Ethylene glycol poisoning and prolonged renal insufficiency of patients registered in Emergency Department
Background
Ethylene glycol poisoning is clinically significant due to the associated risk of severe morbidity or lethality and it continues to occur in many countries around the world. Despite the prevalence and severity of ethylene glycol poisoning, there is a paucity of studies that analyze prognostic factors. This study aims to determine the predictive value of selected factors on the outcomes of death and prolonged renal insufficiency in ethylene glycol poisoned patients.
Material and methods
A retrospective descriptive study was performed, in two university hospitals from N-E region of, Romania, during five years period. Patient’s included were diagnosed with ethylene glycol intoxication or declared at admission toxic alcohols ingestion. The selection of cases was based on the diagnosis received on admission, patients or witness’s statements and the confirmation of laboratory tests. We assessed the predictive value of selected factors on the outcomes of death and prolonged renal failure (RF) from ethylene glycol poisoning and other factors which may have influenced the evolution.
Results and discussion
The present study included 56 patients (aged between 23 and 90, mean age 51.4 years), brought to the hospital by ambulance or by their own means for ethylene glycol poisoning (46.4%, 26 patients declared accidental ingestion, and 15 patients, representing 26.8% declared voluntary ingestion).
The time from the ingestion of ethylene glycol and the admission to hospital was between 40 minutes and 72 hours (mean 13.81+/-18.2) and was higher in dialyzed patients (mean 21.9+/-16.86), represented by 28 cases (50%), compared to patients treated only with the antidote (mean 8.25+/-17.42). The mean value for ethylene glycol quantity declared was 188.9 +/-SD 220.63 ml. 15 patients (26.78%) also declared co-ingestion. There was a male predominance (82.1%); 17.8% were known to have a psychiatric disease (dementia, schizophrenia, depression). The metabolic acidosis was present in up to 66,07% (37 out of 56 patients. These patients were severely symptomatic on arrival and 10 cases (GCS<=4) needed orotracheal intubation and mechanical ventilation. We found that AMS (seizures 1.78%, coma 33.92%) and the need for intubation, were associated with a higher likelihood of RF or death. All of them had a creatinine greater than 1.0 mg/dL and an alkaline reserve (AR) less than 22mmol/L, on arrival.). 16 deaths (28.57%) were recorded (mean age 58.56+/-18.10).
The data analysis (survivors/deceased) showed a correlation between pH (P=0.062), GCS (P=0.007), and increased mortality. In addition, we found a correlation between initial mean values for pH (P=0.0114), AR (P<0.0001), Cr1 (P<0.0001), and peak Cr24 (P<0.0001) with outcomes of RF or death.
Conclusions
Ethylene glycol intoxicated patients are critical from the beginning. This life-threatening situation must be early recognized and establish of an emergency treatment. The early diagnostic and exclusion of other type of poisoning lead to a specific treatment of intoxication. Compared to survivors, patients poisoned with ethylene glycol who died or had prolonged RF were more likely to exhibit clinical signs such as coma, seizures and acidosis. Earlier time-to-hospital was associated with better outcomes.
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