Tanasescu A, Macovei R A, Tudosie M S
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Emergency Hospital Bucharest, Romania.
J Med Life. 2014;7 Spec No. 3(Spec Iss 3):81-6.
Intoxication with ethylene glycol occurs as a result of intentional ingestion in suicide attempts or accidentally. Clinical ethylene glycol poisoning is not specific and occurs in many poisoning cases therefore the diagnosis is difficult. Early diagnostic and establishment of therapy are very important for a favorable evolution. The mortality rate of ethylene glycol intoxication ranges between 1 and 22% depending on the amount of alcohol ingestion and the time period between alcohol ingestion and initiation of therapy.
Retrospectively analyzed data from 18 patients admitted with ethylene glycol poisoning in the emergency department between 2011 and 2012. The following were taken into consideration: incidence of intoxication in the group study, medical history, the amount ingested and the time since the ingestion of ethylene glycol and the admission to hospital, presence of metabolic acidosis and laboratory test results on admission (urea, creatinine osmolar or anion gaps), the treatment initiated and the outcome of the patient.
18 patients with ethylene glycol intoxication were admitted to hospital between 2011 and 2012. The initial diagnosis based on a detailed clinical history in combination with the presence of metabolic acidosis with elevation of the osmolar or anion gaps. 12 of the 18 patients were man (66%) and age range interval was between 23 and 77 years. The time from the ingestion of ethylene glycol and the admission to hospital was between 30 minutes and older than 24 hours. 14 patients have been presented earlier to the hospital, between 30 minutes and 12 hours (in the first part of the clinical stage) and 13 of the 14 patients had a favorable evolution. One of these patients had an unfavorable evolution. Regarding this patient, the amount ingested was unknown. 10 of the 18 patients had a voluntary ingestion (55,55%) and 6 of the 18 patients had an alcoholism medical history. The amount ingested by the patients was between 20 ml and 500 ml. Metabolic acidosis was present up to 55,55% (10 of the 18 patients) in the blood gas analysis on admission, with pH on admission between 6.9 and 7.27, with anion gap ranging between 16.3 mmol/l and 32.6 mmol/l (normal range 8-16 mmol/l). Ten patients also had an increased level of urea and creatinine with a level between 1.24 to 6.85 mg/dl for creatinine (normal range 0.5-1.2 mg/dl) and 49 to 98 mg/dl for urea (normal range 15-43 mg/dl) and developed acute kidney injury that required regular HD sessions. Mechanical ventilation was required for 7 of the 18 patients (38.88%). Five patients died (27.77%). Although metabolic acidosis was corrected under hemodialysis, there were patients who had multiple organ failure and systems: acute respiratory failure requiring ventilator support, acute renal failure requiring dialysis daily sessions, altered state of consciousness.
The early diagnostic and exclusion of the other diseases and other poisoning led to a specific treatment of the intoxication. The time from the ingestion of ethylene glycol and the early establishment of therapy is very important for a favorable evolution and can prevent substantial mortality.
乙二醇中毒可因自杀企图时故意摄入或意外发生。临床乙二醇中毒并无特异性，在许多中毒病例中都会出现，因此诊断困难。早期诊断和确立治疗方法对病情的良好转归非常重要。乙二醇中毒的死亡率在1%至22%之间，具体取决于酒精摄入量以及摄入酒精至开始治疗的时间段。
回顾性分析了2011年至2012年期间在急诊科收治的18例乙二醇中毒患者的数据。考虑了以下因素：研究组中的中毒发生率、病史、摄入量以及摄入乙二醇至入院的时间、代谢性酸中毒的存在情况以及入院时的实验室检查结果（尿素、肌酐、渗透压或阴离子间隙）、开始的治疗以及患者的结局。
2011年至2012年期间有18例乙二醇中毒患者入院。初始诊断基于详细的临床病史，并结合代谢性酸中毒以及渗透压或阴离子间隙升高。18例患者中有12例为男性（66%），年龄范围在23岁至77岁之间。从摄入乙二醇至入院的时间在30分钟至超过24小时之间。14例患者较早入院，时间在30分钟至12小时之间（处于临床阶段的第一部分），这14例患者中有13例病情转归良好。其中1例患者病情转归不佳。关于该患者，摄入量未知。18例患者中有10例为自愿摄入（55.55%），18例患者中有6例有酗酒病史。患者的摄入量在20毫升至500毫升之间。入院时血气分析中高达55.55%（18例患者中的10例）存在代谢性酸中毒，入院时pH值在6.9至7.27之间，阴离子间隙在16. mmol/l至32.6 mmol/l之间（正常范围8 - 16 mmol/l）。10例患者的尿素和肌酐水平也升高，肌酐水平在1.24至6.85毫克/分升之间（正常范围0.5 - 1.2毫克/分升），尿素水平在49至98毫克/分升之间（正常范围15 - 43毫克/分升），并发生了需要定期进行血液透析的急性肾损伤。18例患者中有7例（38.88%）需要机械通气。5例患者死亡（27.77%）。尽管在血液透析下代谢性酸中毒得到了纠正，但仍有患者出现多器官功能衰竭和系统问题：需要呼吸机支持的急性呼吸衰竭、需要每日进行透析的急性肾衰竭、意识状态改变。
早期诊断并排除其他疾病和其他中毒情况可实现中毒的特异性治疗。从摄入乙二醇至早期确立治疗方法对病情的良好转归非常重要，可预防大量死亡。
