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Clinical Features of Reported Ethylene Glycol Exposures in the United States.

Jobson MA, Hogan SL, Maxwell CS, Hu Y, Hladik GA, Falk RJ, Beuhler MC, Pendergraft WF - PLoS ONE (2015)

Bottom Line: Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury.Outcome classification was summed for intentionality and used as a basis for comparison of effect groups.Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care.

View Article: PubMed Central - PubMed

Affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.

ABSTRACT

Background: Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.

Methods and findings: Using the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.

Conclusion: Deaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.

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Related in: MedlinePlus

Logistic regression analysis of risk factors associated with ethylene glycol ingestion.Age is reported in years and each group is compared to age ≤ 18 years. Oral ingestion is compared to all known types of other exposures (unknowns excluded). Listed seasons are compared to Fall. Bonferroni-corrected p-value <0.003 (0.05/17 or 18 comparison variables) is considered significant. (A) Multivariate model of variables associated with intentional ingestion (C-statistic = 0.74). (B) Multivariate model of variables associated with major effect(s) and/or death (C-statistic = 0.92). See S4 Table for additional information.
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pone.0143044.g001: Logistic regression analysis of risk factors associated with ethylene glycol ingestion.Age is reported in years and each group is compared to age ≤ 18 years. Oral ingestion is compared to all known types of other exposures (unknowns excluded). Listed seasons are compared to Fall. Bonferroni-corrected p-value <0.003 (0.05/17 or 18 comparison variables) is considered significant. (A) Multivariate model of variables associated with intentional ingestion (C-statistic = 0.74). (B) Multivariate model of variables associated with major effect(s) and/or death (C-statistic = 0.92). See S4 Table for additional information.

Mentions: Multivariable analysis revealed the following statistically significant predictors of intentional ethylene glycol exposure: age over 18 years, female gender, oral route of exposure, and spring compared to fall (Fig 1A, numerical data in S4 Table). Specifically with regards to gender, more men were exposed to ethylene glycol overall and more men intentionally ingested ethylene glycol; however, this analysis implies that women exposed to ethylene glycol are more likely to experience more serious effects. The risk of intentional ingestion for winter and summer fell between spring and fall and were not statistically distinct from either. Statistically significant predictors of major effect(s) and/or death were also identified: age 30 years and higher, spring compared to fall, and intentionality (Fig 1B). The risks of major effect(s) and/or death in winter and summer were similar to those in spring. These findings were identical when analyzing predictors of major effect(s) or death separately (data not shown). Model discrimination was strong in both models (intentional ingestion C-statistic = 0.74, major effect(s) and/or death C-statistic = 0.92).


Clinical Features of Reported Ethylene Glycol Exposures in the United States.

Jobson MA, Hogan SL, Maxwell CS, Hu Y, Hladik GA, Falk RJ, Beuhler MC, Pendergraft WF - PLoS ONE (2015)

Logistic regression analysis of risk factors associated with ethylene glycol ingestion.Age is reported in years and each group is compared to age ≤ 18 years. Oral ingestion is compared to all known types of other exposures (unknowns excluded). Listed seasons are compared to Fall. Bonferroni-corrected p-value <0.003 (0.05/17 or 18 comparison variables) is considered significant. (A) Multivariate model of variables associated with intentional ingestion (C-statistic = 0.74). (B) Multivariate model of variables associated with major effect(s) and/or death (C-statistic = 0.92). See S4 Table for additional information.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643878&req=5

pone.0143044.g001: Logistic regression analysis of risk factors associated with ethylene glycol ingestion.Age is reported in years and each group is compared to age ≤ 18 years. Oral ingestion is compared to all known types of other exposures (unknowns excluded). Listed seasons are compared to Fall. Bonferroni-corrected p-value <0.003 (0.05/17 or 18 comparison variables) is considered significant. (A) Multivariate model of variables associated with intentional ingestion (C-statistic = 0.74). (B) Multivariate model of variables associated with major effect(s) and/or death (C-statistic = 0.92). See S4 Table for additional information.
Mentions: Multivariable analysis revealed the following statistically significant predictors of intentional ethylene glycol exposure: age over 18 years, female gender, oral route of exposure, and spring compared to fall (Fig 1A, numerical data in S4 Table). Specifically with regards to gender, more men were exposed to ethylene glycol overall and more men intentionally ingested ethylene glycol; however, this analysis implies that women exposed to ethylene glycol are more likely to experience more serious effects. The risk of intentional ingestion for winter and summer fell between spring and fall and were not statistically distinct from either. Statistically significant predictors of major effect(s) and/or death were also identified: age 30 years and higher, spring compared to fall, and intentionality (Fig 1B). The risks of major effect(s) and/or death in winter and summer were similar to those in spring. These findings were identical when analyzing predictors of major effect(s) or death separately (data not shown). Model discrimination was strong in both models (intentional ingestion C-statistic = 0.74, major effect(s) and/or death C-statistic = 0.92).

Bottom Line: Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury.Outcome classification was summed for intentionality and used as a basis for comparison of effect groups.Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care.

View Article: PubMed Central - PubMed

Affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.

ABSTRACT

Background: Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.

Methods and findings: Using the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.

Conclusion: Deaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.

Show MeSH
Related in: MedlinePlus