Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Diego, San Diego, California; VA San Diego Health System, San Diego, California.
Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Diego, San Diego, California.
J Emerg Med. 2022 Jul;63(1):58-61. doi: 10.1016/j.jemermed.2022.04.021. Epub 2022 Aug 4.
Diethylene glycol (DEG) is an industrial solvent with many uses, including brake fluids. It has also caused mass poisonings after use as an inappropriate substitute for propylene glycol or glycerin, though individual ingestions are rare. Like other toxic alcohols, DEG is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase, with toxicity likely mediated by the resulting metabolites. Fomepizole, an alcohol dehydrogenase inhibitor, is used to prevent metabolite formation with other toxic alcohol exposures. Fomepizole is recommended for DEG poisoning, though supporting clinical evidence is limited.
A 31-year-old man presented after ingestion of DEG-containing brake fluid and hydrocarbon-containing "octane booster." He was noted to be clinically intoxicated, with a mildly elevated anion gap metabolic acidosis and no osmolar gap. DEG level was later found to be elevated, consistent with his ingestion. He was treated with fomepizole alone, with resolution of metabolic acidosis and clinical findings over the next 2 days. No delayed neurologic sequelae were present at 52-day follow-up. Our case provides additional evidence supporting the use of fomepizole for DEG poisoning. Consistent with other toxic alcohols, DEG poisoning, especially early presentations, may benefit from empiric fomepizole administration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DEG poisoning is potentially life threatening, but treatable if identified early. An ingestion can be toxic despite a normal osmolar gap, leading to false reassurance. Finally, it is rare, so emergency physicians must be made aware of its potential dangers.
二甘醇（DEG）是一种工业溶剂，用途广泛，包括刹车液。它也曾被用作丙二醇或甘油的不合适替代品而导致大规模中毒，尽管个别摄入的情况很少见。与其他有毒醇类一样，DEG 被乙醇脱氢酶和醛脱氢酶代谢，毒性可能由由此产生的代谢物介导。非那西丁，一种乙醇脱氢酶抑制剂，用于防止其他有毒醇暴露时代谢物的形成。虽然支持的临床证据有限，但推荐使用非那西丁治疗 DEG 中毒。
一名 31 岁男性因摄入含 DEG 的刹车液和含碳氢化合物的“辛烷值增强剂”而就诊。他被发现有临床中毒表现，阴离子间隙代谢性酸中毒轻度升高，渗透压间隙正常。后来发现 DEG 水平升高，与他的摄入一致。他单独接受了非那西丁治疗，代谢性酸中毒和临床症状在接下来的 2 天内得到缓解。在 52 天的随访中没有出现迟发性神经后遗症。我们的病例提供了更多证据支持使用非那西丁治疗 DEG 中毒。与其他有毒醇类一样，DEG 中毒，尤其是早期表现，可能受益于经验性非那西丁治疗。
为什么急诊医生应该了解这一点？：DEG 中毒可能危及生命，但如果及早发现可以治疗。摄入后渗透压间隙正常也可能有毒，从而产生错误的保证。最后，它很少见，因此急诊医生必须意识到它的潜在危险。
