Ethylene glycol is a small molecule (62 dalton) which undergoes rapid absorption from the gastrointestinal tract, distributes to the liver where it is rapidly metabolized by the hepatic alcohol dehydrogenase pathway to toxic metabolites (glycoaldehyde, glycolic acid, glyoxlic acid, oxalic acid, and formic acid), and is excreted in the urine. Triple phosphate crystals or struvite stones: Form in alkaline urine and composed of magnesium, ammonium, and phosphate. This site needs JavaScript to work properly. Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. 2005 Mar;84(1):195-200. doi: 10.1093/toxsci/kfi062. Massive calcium oxalate … Confocal laser scanning microscopy. Some look almost football-shaped; other look more like crystal aggregates. Also, we will not be discussing propylene glycol due to the rarity of its consumption. Epub 2014 Mar 1. Acute ingestions present with altered sensorium and an osmolal gap. Symptoms of ethylene glycol poisoning usually follow a three-step progression, although poisoned individuals will not always develop each stage. The patient was treated with continuous intravenous ethyl alcohol infusion and hemodialysis. [1] Early symptoms include intoxication, vomiting and abdominal pain. 2016;2016:9157393. The presence of crystals in the urine is called Crystalluria. Ethylene glycol exposure is characterized by an osmolal gap and a metabolic acidosis with an elevated anion gap. [1] Later symptoms may include a decreased level of consciousness, headache, and seizures. 1994 Feb 10;114(4):435-6. Ethylene glycol, the predominant constituent of automotive products such as antifreeze and deicers, is an important but uncommon toxicological problem in current medical practice (1)(2). Uric acid crystals in the urine are more tricky because they are pleimorphic–they can have many shapes. Triple phosphate crystals or struvite stones: Form in alkaline urine and composed of magnesium, ammonium, and phosphate. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. 42, No. [1] Long term outcomes may include kidney failure and brain damage. Nephrotoxicity is the dominant effect of significant ethylene glycol poisoning. They can be observed in cases of ethylene glycol toxicity. Clin Toxicol (Phila) 2008;46:322–24. Ethylene glycol intoxication: pathophysiology, diagnosis, and emergency management. Fomepizole is a new agent with a specific indication by the U.S. Food and Drug Administration for the treatment of ethylene glycol poisoning.4, 6, 7, … The left image above is from the urine of a dog with many of these crystals. Quick diagnosis and treatment are essential to prevent renal failure and life-threating complications. Ethylene glycol is a colorless, odorless, sweet-tasting chemical. Please enable it to take advantage of the complete set of features! This site needs JavaScript to work properly.  |  (Anti-freeze) Acidic urine. ... Monohydrate crystals are seen in the ethylene glycol (antifreeze) poisoning. Am J Case Rep. 2018 Jun 14;19:689-693. doi: 10.12659/AJCR.908569. National Library of Medicine. Long term outcomes may include kidney failure and brain damage. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. Forensic Sci Int. Any alcohol when consumed in enough of a quantity can be toxic; however, we will not discuss ethanol as it is not one of the classic “toxic alcohols.” These typically include methanol, ethylene glycol, propylene glycol, and isopropanol (isopropyl alcohol). All animals are susceptible to ethylene glycol (EG) toxicity, but it is most common in dogs and cats. Envelope-like dihydrate calcium oxalate crystals are usually found in the sediment of these patients. Ammonium biurate This can be highly suggestive of ethylene glycol poisoning under the right circumstances. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. Skip to main page content National Institutes of Health. It is most commonly encountered as automotive antifreeze.Diethylene glycol behaves similarly to ethylene glycol in an overdose. 2005 Mar 30;208(3):347-55. doi: 10.1016/j.tox.2004.11.029. The presence of crystals in the urine is called Crystalluria. A urinalysis may also confirm ethylene glycol poisoning and underlying kidney damage by the presence of dilute urine containing blood, protein, cellular casts (plugs of cells which have taken the shape of dying tubules in the kidneys), and calcium oxalate crystals (which are seen with ethylene glycol poisoning). Oval, spindle or dumb-bell forms are infrequently seen in urine from healthy dogs and cats but can be seen in hypercalciuric conditions and ethylene glycol toxicity.Picket fence form (arrow) are commonly observed in ethylene glycol toxicity in dogs and cats, but can also be seen in animals with hypercalciuria due to other causes (e.g. Skip to main page content National Institutes of Health. 2009 Nov;47(9):859-69. doi: 10.3109/15563650903344793. [Cigar-like oxalate crystals in ethylene glycol poisoning]. 3, pp. International Scientific Literature, Ltd. Clin Exp Nephrol. The authors report the case of a man 49 years of age with near-fatal ethylene glycol poisoning. ANNA J. -, Hodgman M, Marraffa JM, Wojcik S, Grant W. Serum calcium concentration in ethylene glycol poisoning. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Chemical properties. Calcium oxalate crystals in the urine are the most common constituent of human kidney stones, and calcium oxalate crystal formation is also one of the toxic effects of ethylene glycol poisoning. PDF. CONCLUSIONS Demonstration of COM crystals using microscopy of a urine sample adds valuable information supporting the clinical suspicion of ethylene glycol poisoning, and may serve as an easy, quick, and cheap method that can be performed in any emergency setting. It is poisonous if swallowed. 2017 Aug;21(4):741-742. doi: 10.1007/s10157-016-1332-2. -, Sankaralingam A, Thomas A, James DR, Wierzbicki AS. Conclusions: Envelope-shaped crystals of calcium oxalate may be seen in the urine except in case of significant renal failure (8). COVID-19 is an emerging, rapidly evolving situation. The classic laboratory profile of ethylene glycol ingestion is an early osmolar gap (the ethylene glycol serves as an unmeasured osmole) that disappears as an anion gap metabolic acidosis develops (as the ethylene glycol is converted into its acidic derivatives). Ammonium biruate crystals can be seen in normal urine. Glycolic acid causes severe acidosis and oxalate precipitates as calcium oxalate in the kidneys and other tissues. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Visual appearance of calcium oxalate crystals (circled above) in a urine sample ( source ) Urine analysis under a Wood’s lamp. NLM 2018 Mar-Apr;8(2):170-178. Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. Assessment of a semi-quantitative screening method for diagnosis of ethylene glycol poisoning. Calcium oxalate crystals in patient urine samples. Calcium Oxalate Monohydrate Crystals: A Clue to Ethylene Glycol Poisoning. Individuals intentionally consume ethylene glycol, usually in the form of antifreeze, as an inexpensive alcohol substitute or as a suicidal agent. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. Lumlertgul N, Siribamrungwong M, Jaber BL, Susantitaphong P. Kidney Int Rep. 2018 Jul 29;3(6):1363-1372. doi: 10.1016/j.ekir.2018.07.020. Ethylene glycol is found in many household products and is a common toxic ingestion. Calcium oxalate monohydrate crystals: a clue to ethylene glycol poisoning. Case report: 2008 Apr;46(4):322-4. doi: 10.1080/15563650701419011. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning?  |  In cases of ethylene glycol poisoning, calcium oxalate may be excreted not only as dihydrate crystals, but also as monohydrate crystals. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. Turillazzi E, Karch SB, Neri M, Pomara C, Riezzo I, Fineschi V. Int J Legal Med. Secondary Oxalate Nephropathy: A Systematic Review. NIH The role of histopathology in forensic practice: an overview. Download Free PDF. 2017;54(4):501–3. Download PDF Package. Urinary crystals … Ethylene glycol is the E in the MUDPILES mnemonic, meaning that it causes an elevated anion gap metabolic acidosis. Blood glucose imbalances Urine fluorescence using a Wood's lamp to detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected ethylene glycol ingestions. Calcium oxalate crystals in acute ethylene glycol poisoning: A confocal laser scanning microscope study in a fatal case. HHS Monohydrate crystals are the predominant form of oxalate crystal seen with ethylene glycol poisoning. Since calcium oxalate monohydrate crystals are transported intracellularly by kidney cells, the renal toxicity of ethylene glycol may result from inhibition of mitochondrial respiratory function in proximal tubular cells by calcium oxalate monohydrate crystals. A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. USA.gov. Calcium Oxalate Monohydrate Crystals: A Clue to Ethylene Glycol Poisoning. Propylene glycol toxicity is seen mainly in an inpatient setting with IV infusions that conta…  |  Calcium oxalate monohydrate crystals in ethylene glycol poisoning. Images in Clinical Medicine from The New England Journal of Medicine — Urinary Calcium Oxalate Crystals in Ethylene Glycol Intoxication The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. 231-234. Epub 2007 Oct 9. Toxicol Sci. Urinary calcium oxalate monohydrate crystals in ethylene glycol poisoning. Ethylene glycol (C2H6O2 Ethylene glycol is an odorless, colorless, sweet-tasting syrupy substance with a molecular weight of 62.07, freezing point of -13°C and a boiling point of 197.6°C. Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. PDF. The cytotoxicity of oxalate, metabolite of ethylene glycol, is due to calcium oxalate monohydrate formation. Envelope-like dihydrate calcium oxalate crystals are usually found in the sediment of these patients. Ethylene glycol may be swallowed accidentally, or it may be taken deliberately in a suicide attempt or as a substitute for drinking alcohol (ethanol). Calcium oxalate crystals in the urine are the most common constituent of human kidney stones, and calcium oxalate crystal formation is also one of the toxic effects of ethylene glycol poisoning. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? Common w/ kidney stones, also toxic effects of ethylene glycol poisoning.  |  Some look almost football-shaped; other look more like crystal aggregates. Clipboard, Search History, and several other advanced features are temporarily unavailable. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. Free PDF. Vittorio Fineschi. Pomara C, Fiore C, D'Errico S, Riezzo I, Fineschi V. Clin Toxicol (Phila). The presence of calcium oxalate or hippurate crystals in the urine, together with an elevated anion gap or osmolal gap, strongly suggests ethylene glycol poisoning (Albertson 1999). Discussion: Calcium oxalate is a combination of calcium ions and the conjugate base of oxalic acid, the oxalate anion. Keywords: Acidosis; Ethylene Glycol, Hyperglycemia, Poisoning; Renal Insufficiency Ethylene Glycol Poisoning; an Unusual Cause of Hyperglycemia: A Case Report 55 after 24 to 48 hours of EG ingestion. NIH 2008 Mar;122(2):173-7. doi: 10.1007/s00414-007-0208-0. The severity of ethylene glycol toxicity is related to the metabolic acidosis resulting from the biotransformation of ethylene glycol into toxic metabolites. Ethylene glycol is found in many household products and is a common toxic ingestion. 2014;51:167–78. Download PDF. 2009 Nov;47(9):859-69. doi: 10.3109/15563650903344793. Singh R, Arain E, Buth A, et al. The dog did not have ethylene glycol poisoning and the crystals are assumed to be secondary to supersaturation of the urine with calcium and oxalates, which precipitated in the acidic urine. Microscopic demonstration of calcium oxalate monohydrate crystals in a urine sample. They can be observed in cases of ethylene glycol toxicity. Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 2011 Apr;341(4):338. doi: 10.1097/MAJ.0b013e3181e15dbd. 1999 Jun;26(3):295-300, 335; quiz 301-2. Case Rep Crit Care. Monohydrate crystals are the predominant form of oxalate crystal seen with ethylene glycol poisoning. Toxicity and death may occur after drinking even a small amount. It is this acid that combines with serum calcium to form the classic calcium oxalate crystals found in the urine of patients who have consumed ethylene glycol.  |  3; Table 1). NLM Accidents involving ethylene glycol ingestion often occur with children. BACKGROUND Ethylene glycol poisoning remains an important presentation to Emergency Departments. Am J Med Sci. Early symptoms include intoxication, vomiting and abdominal pain. PDF. Epub 2016 Sep 2. Calcium Phosphate: Can have different morphologies depending on state of hydration. According to the annual report of the American Association of Poison Control Centers, ethylene glycol … Calcium oxalate crystals in acute ethylene glycol poisoning: A confocal laser scanning microscope study in a fatal case. Direct toxicity, cortical edema, and inhibition of mitochondrial activity, as evidenced by decreased succinate dehydrogenase activity, are possible mechanisms of crystal damage. See this image and copyright information in PMC. 1. The values of glycolic and oxalic acid from samples taken at admission were very high but significantly decreased during therapy (Fig. Microscopic demonstration of calcium oxalate…. Ann Clin Biochem. The classic laboratory profile of ethylene glycol ingestion is an early osmolar gap (the ethylene glycol serves as an unmeasured osmole) that disappears as an anion gap metabolic acidosis develops (as the ethylene glycol is converted into its acidic derivatives). Toxicological examinations revealed ethylene glycol; the blood level was 250 mg/L and in urine the concentration was 0.3%. ... Monohydrate crystals are seen in the ethylene glycol (antifreeze) poisoning. -, Pomara C, Fiore C, D’Errico S, et al. Later symptoms may include a decreased level of consciousness, headache, and seizures. Discussion: In cases of ethylene glycol poisoning, calcium oxalate may be excreted not only as dihydrate crystals, but also as monohydrate crystals. Massive calcium oxalate … Introduction: Clinical Toxicology, 2008. Massive calcium oxalate crystalluria was observed in all poisoned dogs. Acute ingestions present with altered sensorium and an osmolal gap. They generally only form in an acidic urine. Forensic Sci Med Pathol. Calcium oxalate crystals in acute ethylene glycol poisoning: a confocal laser scanning microscope study in a fatal case. Most intoxications are associated with ingestion of antifreeze, which is typically 95% EG. Epub 2005 Jan 21. Two days after admission, the patient was awake and in clinical recovery. Chemical properties. 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