Printer Friendly

Positive propylene glycol result in a patient with ethylene glycol poisoning.

CASE DESCRIPTION

A 61-year-old man presented with an increased anion-gap metabolic acidosis, an increased serum osmolal gap, and a negative result in an alcohol screen. Gas chromatography revealed an increased ethylene glycol (EG) [2] concentration (22 mg/dL) and a propylene glycol (PG) result that was below the lower limit of quantification (<5 mg/dL) (Fig. 1A). The patient was treated with hemodialysis, followed by phenytoin and a high-dose lorazepam infusion for a witnessed seizure. By 13 h, the EG concentration had fallen below the lower limit of quantification (<5 mg/dL); however, a peak identified as PG was observed, corresponding to a concentration of 27 mg/dL (Fig. 1B).

[FIGURE 1 OMITTED]

QUESTIONS

1. What are the common causes of EG or PG poisoning?

2. What could cause a positive EG result and then a positive PG result in this patient?

3. What is the difference in toxicity between EG and PG?

The answers are on the next page.

ANSWERS

Ingesting automotive fluids, such as antifreeze containing EG or PG, can cause poisoning (1, 2). PG is also a solvent in many pharmaceuticals. Intravenous infusion of large amount of medications that use PG as a vehicle can cause PG poisoning (3-5). In our case, consumption of antifreeze led to the initial positive EG result, and the phenytoin treatment and a subsequent high-dose lorazepam infusion, both which contained PG, led to the positive PG result. This substance is less toxic than EG; however, poisoning cases associated with overdose of medications with PG as diluent have been described (3-5).

Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, oranalysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

Authors' Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.

References

(1.) Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th annual report. Clin Toxicol (Phila) 2011;49: 910-41.

(2.) Litovitz TL, Smilkstein M, Felberg L, Klein-Schwartz W, Berlin R, Morgan JL. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1997;15:447-500.

(3.) Wilson KC, Reardon C, Theodore AC, Farber HW. Propylene glycol toxicity: a severe iatrogenic illness in ICU patients receiving IV benzodiazepines: a case series and prospective, observational pilot study. Chest 2005;128:1674-81.

(4.) Cawley MJ. Short-term lorazepam infusion and concern for propylene glycol toxicity: case report and review. Pharmacotherapy 2001;21:1140-4.

(5.) Yaucher NE, Fish JT, Smith HW, Wells JA. Propylene glycol-associated renal toxicity from lorazepam infusion. Pharmacotherapy 2003;23:1094-9.

Zengliu Su, [1] Roger W. Stone, [1] and Yusheng Zhu [1] *

[1] Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC.

* Address correspondence to this author at: Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Ave., MSC 908, Suite 309, Charleston, SC 29425. Fax: 843-792-0424; e-mail zhuyu@musc.edu.

Received June 4, 2013; accepted June 24, 2013.

DOI: 10.1373/clinchem.2013.210823

[2] Nonstandard abbreviations: EG, ethylene glycol; PG, propylene glycol.
COPYRIGHT 2014 American Association for Clinical Chemistry, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:the Clinical Chemist: What Is Your Guess?
Author:Su, Zengliu; Stone, Roger W.; Zhu, Yusheng
Publication:Clinical Chemistry
Article Type:Clinical report
Geographic Code:1USA
Date:Apr 1, 2014
Words:558
Previous Article:A case of green blood.
Next Article:A two-pronged approach.
Topics:

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters