Ethylene glycol intoxication misdiagnosed as eclampsia

Abstract

Ethylene glycol intoxication is one of the most serious acute poisonings with very uncertain prognosis with regard to both recovery and survival. A case report is presented in which a woman who was admitted for the termination of pregnancy by Caesarean section with a diagnosis of eclampsia turned out to be severely intoxicated by ethylene glycol.

Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

“…Mortality from the entire cohort was 18.7% and the median time to death was 96 h after ingestion. Some patients with massive ingestions (> 1 L) or very high EG concentrations (> 200 mmol/L or > 1240 mg/dL) survived [ 123 , 214 , 238 , 274 , 281 , 282 ], as did some with extreme acid–base abnormalities (e.g., pH < 6.60 or HCO 3 − < 2 mmol/L) [ 25 , 26 , 29 , 104 , 180 , 190 , 191 , 215 , 223 , 226 , 236 , 244 , 248 , 254 , 257 , 264 , 276 ]. As suggested in one review [ 71 ], poor outcomes were infrequent when the glycolate concentration is < 12 mmol/L or the anion gap (with potassium, calculated as Na + + K + – Cl - – HCO 3 − ) is < 28 mmol/L (Additional file 1 : Table S10); three such patients who received ECTR died, in two cases there were limited details reported [ 51 ], and one died without receiving an ADH inhibitor [ 126 ].…”

Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report

“…Late-obstetric ethylene glycol intoxication is a rare, lifethreatening event (1). Hallmark signs and symptoms can mimic those of late pregnancy-related high blood pressure disorders (2). Thus, ethylene glycol intoxication during late pregnancy needs to be recognized early so that specific treatment modalities can be initiated (3).…”

Ethylene glycol and other solvent use in pregnancy: a new phenomenon and a new diagnostic dilemma

“…It is with interest that I read the recent (and timely) article by Kralova et al (1) describing the case of ethylene glycol intoxication in pregnancy. Ethylene glycol is an inexpensive, readily available (as it is used as the active antifreeze principle in radiator water additives) substance (solvent) that may be associated with accidental or intentional toxicity in humans (2).…”

“…Many substance‐abusing adults (including parturients) are exposed to ethylene glycol when it is ingested as a cheap substitute for ethanol (3). Severe ethylene glycol poisoning has been reported to mimic several serious medical conditions including eclampsia (1), a pregnancy specific disorder, or an acute basilar artery occlusion (4), a neurological disorder. Unfortunately, the public awareness of the dangers of antifreeze (ethylene glycol) and other solvent intake for recreation purposes is very limited.…”

“…Optimal obstetric and anesthetic management of solvent‐abusing parturients requires a high level of suspicion and early diagnosis (1,6). Altered perception of sensory stimuli, loss of coordination, headache, nausea, vomiting, and respiratory compromise, may result from solvent sniffing.…”