Triethylene Glycol Poisoning Treated with Intravenous Ethanol Infusion

• Published in: Journal of toxicology. Clinical toxicology Vol. 37; no. 6; pp. 773 - 776
• Main Authors: Vassiliadis, John, Graudins, Andis, Dowsett, Robert P.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Monticello, NY Informa UK Ltd 1999; Taylor & Francis; Dekker
• Subjects: acidemia; Acidosis - blood; Acidosis - chemically induced; Acidosis - drug therapy; Adult; Antidotes - therapeutic use; Biological and medical sciences; Chemical and industrial products toxicology. Toxic occupational diseases; Coma - chemically induced; Coma - drug therapy; Ethanol - administration & dosage; Ethanol - therapeutic use; Female; Humans; Infusions, Intravenous; Medical sciences; Polyethylene Glycols - chemistry; Polyethylene Glycols - poisoning; Suicide, Attempted; Toxicology; Treatment Outcome; triethylene glycol; Various organic compounds; Coma; Human; Nervous system diseases; Ethanol; Enzyme; Toxicity; Consciousness impairment; Oral administration; Enzyme inhibitor; Alcohol dehydrogenase; Metabolism; Acidemia; Case study; Chemotherapy; Treatment; Poisoning; Oxidoreductases; Neurological disorder; Resuscitation
• ISSN: 0731-3810; 1097-9875
• DOI: 10.1081/CLT-100102455

Introduction: Poisoning with triethylene glycol has been rarely reported in humans. Triethylene glycol is thought to be metabolized by alcohol dehydrogenase to acidic products resulting in the production of a metabolic acidemia. Triethylene glycol metabolism has previously been shown to be inhibited by fomepizole (4-methyl pyrazole) administration. We report a case of triethylene glycol ingestion, presenting with a metabolic acidemia, treated with intravenous ethanol administration. Case Report: A 23-year-old female presented to the emergency department approximately 1-1.5 hours following ingestion of a gulp of triethylene glycol (99%) brake fluid with coma (GCS-3) and metabolic acidemia (pH 7.03, Pco2 44 mm Hg, Bicarbonate 11 mmol L, anion gap 30 mmol L, serum creatinine 90 μmol L). She was intubated and given 100 mmol of intravenous sodium bicarbonate. An ethanol loading dose was administered followed by an infusion to maintain serum ethanol at 100 mg dL. Acidemia gradually resolved over the next 8 hours and she was extubated 12 hours later. The ethanol infusion was continued for a total of 22 hours. There was no recurrence of acidemia. Serum ethanol, ethylene glycol, and methanol levels were nondetectable on presentation, as was serum salicylate. Urine drug of abuse screen and thin-layer chromatography revealed no other coingested substances. The patient was discharged to a psychiatric ward 36 hours postingestion. Conclusion: Pure triethylene glycol poisoning results in coma and metabolic acidemia and may be treated with alcohol dehydrogenase inhibitors such as ethanol.