Case Report
Volume 8 Issue 11 - 2020
A Sweet Poison - An Anti-freeze Ingestion in a Tropical Setting
P Singh1*, T Lim2, H Frieslich2 and J Soderstrom3
1Children’s Critical Care Unit, Gold Coast University Hospital, Queensland, Australia
2Department of Pediatric Emergency, Gold Coast University Hospital, Queensland, Australia
3Clinical Toxicologist, Department of Emergency, Royal Perth Hospital, Australia
*Corresponding Author: P Singh, Children’s Critical Care Unit, Gold Coast University Hospital, Queensland, Australia.
Received: January 19, 2020; Published: October 09, 2020

Background: Ethylene Glycol is a colourless, odorless, viscous dihydroxy alcohol with a sweet taste. It is the most widely available glycol commercially and is used as an anti-freeze and coolant in hydraulic fluids and manufacture of low freezing dynamites and resins. It is readily absorbed from the gastrointestinal tract. Timely recognition of Ethylene Glycol ingestion is important to institute specific antidote and to be able to watch for toxin-related potential complications.

Methods: Our very unusual case is a 20 month old child who was brought to our emergency department with altered sensorium and ataxia of uncertain aetiology. The Child was previously healthy with no medical concerns. He developed neurological symptoms after milk formula ingestion. On systematic assessment blood tests showed increased anion gap metabolic acidosis with an elevated osmolar gap. Toxicology team was consulted regarding potential cause and management.

Result: Very few chemicals produce such a typical blood chemistry of increased anion gap metabolic acidosis with a high osmolar gap. Laboratory results showed raised blood Ethylene Glycol levels. Further questioning of the child carer's revealed accidental use of Ethylene Glycol instead of bottled water to prepare child's milk formula. The child received intravenous Ethyl Alcohol as an antidote, intubated for airway protection and haemodialysis given high Ethyl Glycol levels. The child made a complete recovery with appropriate and timely management.

Conclusion: Ethylene Glycol can produce severe central nervous system toxicity, renal toxicity, acid-base disturbance and even death. Appropriate history taking and investigations can channelize towards the right diagnosis, an institution of specific antidote and supportive therapy. Our patient showed complete neurological and renal function recovery even after an extremely toxic dose of Ethylene Glycol.

Keywords: Ethylene Glycol Poisoning; Ethyl Alcohol; Metabolic Acidosis; Osmolar Gap


  1. Eder AF., et al. “Ethylene glycol poisoning: toxicokinetic and analytical factors affecting laboratory diagnosis”. Clinical Chemistry 1 (1998): 168-177.
  2. Barceloux DG., et al. “American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee”. Journal of Toxicology: Clinical Toxicology 5 (1999): 537-560.
  3. Harry P., et al. “Ethylene glycol poisoning in a child treated with 4-methylpyrazole”. Pediatrics3 (1998): E31.
  4. Peterson CD., et al. “Ethylene glycol poisoning: pharmacokinetics during therapy with ethanol and hemodialysis”. The New England Journal of Medicine 1 (1981): 21-23.
  5. De Chazal I., et al. “The 'sweet killer'. Can you recognize the symptoms of ethylene glycol poisoning?” Postgraduate Medical Journal 4 (1999): 221-224.
  6. Caravati EM., et al. “Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management”. Clinical Toxicology 5 (2005): 327-345.
  7. Brent J. “Current management of ethylene glycol poisoning”. Drugs7 (2001): 979-988.
  8. Scalley RD., et al. “Treatment of ethylene glycol poisoning”. American Family Physician 5 (2002): 807-812.
  9. Church AS and Witting MD. “Laboratory testing in ethanol, methanol, ethylene glycol, and isopropanol toxicities”. The Journal of Emergency Medicine 5 (1997): 687-692.
  10. Davis DP., et al. “Ethylene glycol poisoning: case report of a record-high level and a review”. The Journal of Emergency Medicine 5 (1997): 653-667.
  11. Brent J., et al. “Fomepizole for the treatment of ethylene glycol poisoning”. The New England Journal of Medicine 11 (1999): 832-838.
  12. Frommer JP and Ayus JC. “Acute ethylene glycol intoxication”. American Journal of Nephrology 1 (1982): 1-5.
  13. Krasowski MD. “Educational Case: Ethylene Glycol Poisoning”. Academic Pathology 7 (2020): 2374289519900330.
  14. Loriaux D., et al. “Ethylene Glycol Toxicity in the Setting of Recurrent Ingestion: A Case Report and Literature Review”. Cureus4 (2019): e4375.
  15. Singh R., et al. “Ethylene Glycol Poisoning: An Unusual Cause of Altered Mental Status and the Lessons Learned from Management of the Disease in the Acute Setting”. Case Reports in Critical Care (2016): 9157393.
  16. Tuero G., et al. “Value of glycolic acid analysis in ethylene glycol poisoning: A clinical case report and systematic review of the literature”. Forensic Science International 290 (2018): e9-e14.
Citation: P Singh., et al. “A Sweet Poison - An Anti-freeze Ingestion in a Tropical Setting”. EC Pharmacology and Toxicology 8.11 (2020): 47-50.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before August 09, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to