Diethylene glycol poisoning: report of two cases due to brewery contamination

Abstract

Context: Diethylene glycol (DEG) is an alcohol used as industrial antifreeze. Poisoning is usually accidental and involves contamination of food and beverage. We report two cases of DEG poisoning (DEGP) resulting from ingestion of beer in 2020. Case report: ACMO, male, 57 year-old, admitted with bilateral visual turbidity complaint. Laboratory showed renal dysfunction (Cr 11 mg/dl, Ur 202 mg/dl), increased anion GAP (AG) and metabolic acidosis. He evolved with amaurosis, facial diplegia, tetraparesis and areflexia. He was discharged after prolonged hospitalization with severe motor impairment, bilateral amaurosis and under dialysis therapy. RJB, 75 year-old alcoholic male patient, reported 600 ml/day ingestion of high-risk beer in the month preceding his hospitalization. He was admitted with nausea, abdominal pain, renal failure (Cr 11 mg/dl, Ur 177 mg/dl), metabolic acidosis and AG 21. He developed bilateral papilla edema, flaccid tetraparesis, areflexia, dysautonomy, respiratory failure and death. Conclusions: DEG metabolites primarily target kidneys and nervous system. Patients shortly develop nephroneural syndrome characterized by acute oligoanuric renal injury with metabolic acidosis and increased AG, associated with peripheral polyneuropathy with involvement of cranial nerves, in addition to optic neuropathy. Due to the poorly available serum dosage, rapid recognition of DEGP is essential to institute early treatment and identification of the source of the intoxication in order to prevent mass poisoning.