Medical Management Guidelines for Ethylene Glycol
(C
2H
6O
2)
CAS# 107-21-1
PDF Versionpdf icon[157 KB]
Synonyms include 1,2-dihydroxyethane, 1,2-ethanediol, 2-hydroxyethanol, ethylene alcohol, glycol, glycol alcohol, monoethylene glycol, and ethylene dihydrate. Ethylene glycol is sold under a variety of brand names as automobile radiator antifreeze. It should not be confused with ethylene glycol ethers, which are a different group of chemicals.
- Persons exposed to ethylene glycol do not pose a significant risk of secondary contamination to response personnel outside the Hot Zone.
- Ethylene glycol is a clear, odorless, slightly viscous liquid. It is combustible and has a low vapor pressure. Odor does not provide any warning of hazardous concentrations.
- Ingestion is the most important exposure route. Dermal absorption is negligible and does not contribute significantly to systemic toxicity.
- Significant inhalation exposure does not occur at room temperature, but respiratory tract irritation is possible when the liquid is heated, agitated, or sprayed.
General Information
Description
Ethylene glycol is a clear, odorless,
slightly viscous liquid with a sweet taste. It is
combustible and has a low vapor pressure. Ethylene glycol is
a very useful industrial compound because of its low
freezing point and high boiling point. It is widely
available as automotive antifreeze; in that application, it
is often mixed with a yellow-green fluorescent.
Routes of Exposure
Inhalation
Toxic inhalation of ethylene glycol is
unlikely at room temperature because of the chemical's low
volatility, but can occur when the liquid is heated,
agitated, or sprayed. Ethylene glycol is odorless and thus,
odor does not provide any warning of hazardous
concentrations. Ethylene glycol vapor is lighter than
air.
Children exposed to the same levels of
ethylene glycol as adults may receive larger doses because
they have greater lung surface area:body weight ratios and
increased minute volumes:weight ratios.
Skin/Eye Contact
Ethylene glycol is only mildly
irritating to mucous membranes or skin and is slowly and
poorly absorbed through the skin.
Ingestion
Ethylene glycol is rapidly absorbed
following ingestion, which is the predominant route of
exposure. Ingestion of ethylene glycol leads to systemic
toxicity beginning with CNS effects, followed by
cardiopulmonary effects, and finally renal failure.
Sources/Uses
Ethylene glycol is produced
commercially in large amounts and widely used as an
antifreeze and de-icer. It is also used in chemical
synthesis, including synthesis of plastics, films, and
solvents. Ethylene glycol can be found in many consumer
products, including automotive antifreeze, hydraulic brake
fluids, inks used in some stamp pads, ballpoint pens,
solvents, paints, plastics, and solar energy systems.
Standards and Guidelines
ACGIH ceiling limit = 100 mg/mĀ³ (39
ppm)
Physical Properties
Description: odorless,
colorless, slightly viscous, sweet-tasting liquid. Many
antifreeze products also contain yellow-green fluorescent
dyes and a bitter taste to reduce the chances of accidental
ingestion.
Warning properties: odor is
inadequate to protect against acute inhalation exposure
Molecular weight: 62.07 daltons
Boiling point (760 mm HG): 387ĀŗF
(198ĀŗC)
Freezing point: 8.6ĀŗF (-13ĀŗC)
Specific gravity: 1.11 at 68ĀŗF
(20ĀŗC) (water = 1)
Vapor pressure: 0.06 mm Hg at
68ĀŗF (20ĀŗC)
Gas density: 0.092 (air = 1)
Water solubility: miscible with
water; can absorb twice its weight of water
Flammability: 232ĀŗF (111ĀŗC)
Flammable range: 3.2% to 21.6%
(concentration in air)
Incompatibilities
Ethylene glycol reacts with strong
oxidizers and acids, including chromium trioxide, potassium
permanganate, sodium peroxide, potassium dichromate,
chlorosulfonic acid, sulfuric acid, perchloric acid, and
diphosphorous pentasulfide.
Health Effects
- Ethylene glycol is only mildly irritating to skin and
mucous membranes and is not absorbed well through the skin
or by inhalation.
- Ingestion of ethylene glycol produces CNS depression
which may be accompanied by nausea, vomiting, and abdominal
cramps.
- Metabolites of ethylene glycol produce severe metabolic
acidosis and damage to the brain, heart, and kidneys.
- Severe poisoning is potentially fatal if treatment is
inadequate or delayed.
Acute Exposure
Ethylene glycol is a dehydrating agent
and is mildly irritating to the skin and mucous membranes
after prolonged contact.
Upon ingestion, it is rapidly absorbed
(within 1 to 4 hours). Less than 20% is excreted
unmetabolized; most is successively metabolized to very
toxic compounds. A characteristic progression of toxic
effects can be roughly divided into three stages, although
overlap is possible:
Stage 1: From 30 minutes to 12
hours after exposure, unmetabolized ethylene glycol produces
CNS depression, intoxication, and hyperosmolarity similar to
that produced by ethanol.
Stage 2: From 12 to 48 hours,
metabolites produce severe acidosis with compensatory
hyperventilation. The acidosis is primarily the result of an
increase in glycolic acid, although glyoxylic, oxalic, and
lactic acids also contribute in small part. Calcium oxalate
crystals are deposited in the brain, lungs, kidneys, and
heart.
Stage 3: From 24 to 72 hours,
the direct toxic effects of ethylene glycol metabolites in
the kidneys can cause acute renal failure.
Children do not always respond to
chemicals in the same way that adults do. Different
protocols for managing their care may be needed.
CNS
Unmetabolized ethylene glycol can
produce an ethanol-like intoxication. Symptoms include
dizziness, ataxia, disorientation, irritation, restlessness,
nystagmus, headache, slurred speech, and somnolence. Severe
poisoning can lead to coma and death. Cerebral edema and
deposits of calcium oxalate crystals in the walls of small
blood vessels contribute to the CNS toxicity.
Renal
Kidney toxicity is a major consequence
of ethylene glycol absorption. Acute cell death (i.e.,
tubular necrosis) and kidney failure can occur within 24 to
28 hours as a result of the direct cytotoxic action of
oxalic, glyoxylic, and glycolic acids or due to
precipitation of calcium oxalate crystals in the renal
tubules. Focal tubular degeneration, atrophy, and tubular
interstitial inflammation have also been observed. Renal
damage, if untreated, can lead to acute oliguric renal
failure and can necessitate long-term hemodialysis. The
resulting hyperkalemia can cause life-threatening cardiac
dysrhythmias.
Metabolic
An osmolar gap can be present early
after ingestion; this represents unmetabolized ethylene
glycol. It will resolve as metabolism proceeds. A severe
metabolic acidosis with elevated anion gap develops as
metabolism to glycolic, glyoxylic, and oxalic acids occurs.
Large quantities of sodium bicarbonate can be administered
without affecting the acidosis because of the ongoing
generation of acid metabolites. However, over zealous
alkanization could cause ionized calcium deficits.
Hypocalcemia and tetany can occur as a result of calcium
oxalate deposition.
Respiratory
Very high levels of inhaled ethylene
glycol vapors can irritate the upper respiratory tract.
Levels higher than 80 ppm produce intolerable respiratory
discomfort and cough. Ethylene glycol's CNS effects can
cause respiratory depression, and metabolic acidosis can
result in hyperventilation and respiratory alkalosis.
Aspiration of ethylene glycol following ingestion can result
in pulmonary edema.
Children may be more vulnerable to gas
exposure because of relatively increased minute ventilation
per kg and failure to evacuate an area promptly when
exposed.
Cardiovascular
Cardiovascular effects include
tachycardia, dysrhythmias, congestive heart failure,
hypertension or hypotension, and circulatory collapse.
Hyperkalemia resulting from kidney toxicity can cause
life-threatening cardiac dysrhythmias.
Gastrointestinal
Nausea and vomiting can be present in
the initial stage of intoxication.
Dermal
Ethylene glycol is a minor skin
irritant, although a few cases of allergic contact
dermatitis have been reported.
Ocular
Mild ocular irritation may occur after
contact with ethylene glycol.
Potential Sequelae
Renal failure can occur 24 to 72 hours
after an acute ingestion and can necessitate hemodialysis.
Some loss of renal function can be permanent. There are
infrequent reports of cranial nerve palsies (e.g., facial
palsy, hearing loss, visual disturbances) or peripheral
neuropathy one or more weeks after an acute poisoning.
Chronic Exposure
There are only a few reports on the
adverse health effects in humans of chronic exposure to
ethylene glycol. Irritation of the throat, mild headache,
low backache, loss of consciousness, and nystagmus have been
reported. These symptoms were resolved when the exposure
ceased.
Carcinogenicity
The U.S. Department of Health and Human
Services (DHHS), the International Agency for Research on
Cancer (IARC) and EPA have not classified ethylene glycol in
terms of its carcinogenic potential. Studies in humans and
animals have not yielded any associations between ethylene
glycol exposure and the incidence of any cancer.
Reproductive and Developmental Effects
Ethylene glycol is not included in
Reproductive and Developmental Toxicants, a 1991 report
published by the U.S. General Accounting Office (GAO) that
lists 30 chemicals of concern because of widely acknowledged
reproductive and developmental consequences. Some
experimental animal studies of exposure to glycols have
shown teratogenicity, specifically craniofacial and neural
tube closure defects and skeletal dysplasia. Human effects
are not known or documented.
Prehospital Management
- Persons exposed to ethylene glycol liquid or vapor do
not pose significant risks of secondary contamination to
rescuers.
- Ethylene glycol is a CNS depressant, similar to ethanol.
Its metabolites are toxic and cause profound metabolic
acidosis, cerebral edema, cardiovascular collapse, acute
renal failure, and possibly death.
- Timely treatment is effective and consists of supportive
care, hemodialysis, and administration of a specific
antidote.
Hot Zone
Rescuers should be trained and
appropriately attired before entering the Hot Zone. If the
proper equipment is not available, or if the rescuers have
not been trained in its use, call for assistance from a
local or regional HAZMAT team or other properly equipped
response organization.
Rescuer Protection
Ethylene glycol is a mild respiratory
tract irritant. It is not well absorbed through the lungs or
skin.
Respiratory Protection:
Respirable concentrations of ethylene glycol are significant
only when the liquid is heated (e.g., during a fire) or
aerosolized. Positive-pressure, self-contained breathing
apparatus (SCBA) is recommended under these circumstances.
Skin Protection:
Chemical-protective clothing is generally not required
because ethylene glycol (whether vapor or liquid) is only a
minor skin irritant and is absorbed poorly and slowly
through the skin.
ABC Reminders
Quickly access for a patent airway,
ensure adequate respiration and pulse. If trauma is
suspected, maintain cervical immobilization manually and
apply a cervical collar and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys. If
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of
chemically contaminated children, such as measures to reduce
separation anxiety if a child is separated from a parent or
other adult.
Decontamination Zone
Victims exposed only to ethylene glycol
vapor who have no skin or eye irritation do not need to
undergo decontamination. These individuals may be
transferred immediately to the Support Zone. Others can
undergo decontamination, but even severely exposed victims
need only external decontamination (see Basic
Decontamination below) because ingestion is the major
toxic exposure route.
Rescuer Protection
Ethylene glycol acts as a systemic
toxicant only when ingested. Rescuers need not take any
special precautions.
ABC Reminders
Quickly access for a patent airway,
ensure adequate respiration and pulse. Stabilize the
cervical spine with a collar and a backboard if trauma is
suspected. Administer supplemental oxygen as required.
Assist ventilation with a bag-valve-mask device if
necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Quickly remove and double-bag
contaminated clothing and personal belongings.
Wash exposed skin and hair with mild
soap and water (preferably under a shower). Rinse thoroughly
with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or
warmers when appropriate.
Irrigate exposed eyes with plain water
or saline for at least 15 minutes. Remove contact lenses if
easily removable without additional trauma to the eye. If
pain or injury is evident, continue irrigation while
transferring the victim to the Support Zone.
In cases of recent ingestion (less than
one hour), in an alert, awake patient, emesis may be induced
with ipecac. For other patients, perform gastric lavage.
Early treatment is important to reduce absorption of
ethylene glycol and subsequent production of highly toxic
metabolites. Activated charcoal absorbs ethylene glycol
poorly, but may be of use if there is suspicion of multiple
chemical ingestion. Administer activated charcoal at 1 gm/kg
(usual adult dose 60-90 g, child dose 25-50 g).
Consider appropriate management of
chemically contaminated children at the exposure site. Also,
provide reassurance to the child during decontamination,
especially if separation from a parent occurs. If possible,
seek assistance from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is
complete, move the victim to the Support Zone.
Support Zone
Victims pose no serious risk of
secondary contamination to rescuers. Therefore, Support Zone
personnel require no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization
manually and apply a cervical collar and a backboard when
feasible. Ensure adequate respiration and pulse. Administer
supplemental oxygen as required and establish intravenous
access if necessary. Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of recent ingestion (less than
one hour), in an alert, awake patient, emesis may be induced
with ipecac. For other patients, perform gastric lavage (if
the patient has not already undergone gastric lavage in the
Decontamination Zone). Early treatment is important to
reduce absorption of ethylene glycol and subsequent
production of highly toxic metabolites. Activated
charcoal absorbs ethylene glycol poorly, but may be of use
if there is suspicion of multiple chemical ingestion.
Administer activated charcoal at 1 gm/kg (usual adult dose
60-90 g, child dose 25-50 g).
Advanced Treatment
In cases of respiratory compromise
secure airway and respiration via endotracheal intubation.
If not possible, perform cricothyroidotomy if equipped and
trained to do so.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be
treated according to advanced life support (ALS) protocols.
A pH of less than 7.0 and a serum
bicarbonate of less than 7 mmol/L are common with severe
ethylene glycol intoxication. Treatment of this metabolic
acidosis may be difficult. Liberal use of sodium bicarbonate
solution is appropriate to correct the acidemia.
Transport to Medical Facility
Only decontaminated patients or
patients not requiring decontamination should be transported
to a medical facility. "Body bags" are not recommended.
Report to the base station and the
receiving medical facility the condition of the patient,
treatment given, and estimated time of arrival at the
medical facility.
Vomit containing ethylene glycol
requires no chemical safety precautions since there is
little exposure potential or risk of secondary
contamination.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients with evidence suggesting
ingestion of ethylene glycol should be rapidly transported
to a medical facility for evaluation. All patients who have
ingested more than a taste or sip of ethylene glycol, even
if asymptomatic, should be evaluated in a hospital where
appropriate laboratory studies can be carried out. Delays in
treatment can result in more severe toxicity and potentially
irreversible damage to major organ systems.
Patients with a history suggesting
insignificant exposure and who have no symptoms of ethylene
glycol toxicity may be discharged from the scene after their
names, addresses, and telephone numbers have been recorded.
Those discharged should be advised to seek medical care
promptly if symptoms develop (see Patient Information
Sheet below).
Emergency Department Management
- Patients exposed to ethylene glycol liquid or vapor pose
no risk of secondary contamination to hospital personnel.
- Ethylene glycol is only mildly irritating to skin and
mucous membranes and is not absorbed well through the skin
or by inhalation.
- Ingestion of ethylene glycol causes CNS depression. If
the patient is not treated, ethylene glycol's metabolites
can cause acidosis, hyperventilation, and renal failure
requiring hemodialysis.
- Timely treatment is effective and consists of supportive
care, hemodialysis, and administration of a metabolic
antidote such as ethanol or 4-methylpyrazole (fomepizole).
Decontamination Area
Patients exposed to ethylene glycol do
not require extensive decontamination. Remove contaminated
clothing and personal belongings.
Be aware that use of protective
equipment by the provider may cause fear in children,
resulting in decreased compliance with further management
efforts.
Emergency room personnel should examine
children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, surgically create an airway.
Patients who are comatose, hypotensive,
or have seizures or ventricular dysrhythmias should be
treated in the conventional manner.
A pH of less than 7.0 and a serum
bicarbonate of less than 7 mmol/L are common with severe
ethylene glycol intoxication. Treatment of this metabolic
acidosis may be difficult. Liberal use of sodium bicarbonate
solution is appropriate to correct the acidemia.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag
contaminated clothing and personal belongings.
Wash exposed skin and hair with mild
soap and water (preferably under a shower). Rinse thoroughly
with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or
warmers when appropriate.
Flush exposed or irritated eyes with
plain water or saline for at least 15 minutes. Remove
contact lenses if easily removable without additional trauma
to the eye. If pain or injury is evident, continue
irrigation while transferring the victim to the Critical
Care Area.
In cases of substantial recent
ingestion (less than 1 hour), where the patient is alert and
awake, emesis can be induced with ipecac. In unconscious or
symptomatic patients, consider gastric lavage if it can be
administered within 1 hour of ingestion. Activated charcoal
absorbs ethylene glycol poorly, but may be of use if there
is suspicion of ingestion of multiple chemicals. Administer
activated charcoal at 1 gm/kg (usual adult dose 60-90 g,
child dose 25-50 g). Ethylene glycol is rapidly absorbed and
little benefit is expected from these procedures if more
than an hour has elapsed. Early antidotal treatment with
ethanol or 4-methylpyrazole to prevent formation of toxic
metabolites is the most effective intervention. (More
information is provided in Antidotes and Other Treatments
under Critical Care Area below)
Critical Care Area
ABC Reminders
Evaluate and support the airway,
breathing, and circulation as in ABC Reminders above.
Establish intravenous access in seriously ill patients if
this has not been done previously. Continuously monitor
cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated in
the conventional manner.
A pH of less than 7.0 and a serum
bicarbonate of less than 7 mL/dL are common with severe
ethylene glycol intoxication. Treatment of this metabolic
acidosis may be difficult. Liberal use of sodium bicarbonate
solution is appropriate to correct the acidemia.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints.
Skin Exposure
In most cases, no further treatment is
needed after washing. If irritation or allergic contact
dermatitis occurs, treatment with emollient creams,
antihistamines, or topical steroids might be indicated.
Eye Exposure
Ensure that adequate eye irrigation has
been completed. Test visual acuity. Examine the eyes for
conjunctival or corneal damage and treat appropriately.
Immediately consult an ophthalmologist for patients with
suspected severe corneal injuries.
Ingestion Exposure
In cases of substantial recent
ingestion where the patient is alert and awake, emesis can
be induced with ipecac. In unconscious or symptomatic
patients, consider gastric lavage if it can be administered
within 1 hour of ingestion. Activated charcoal absorbs
ethylene glycol poorly, but may be of use if there is
suspicion of ingestion of multiple chemicals. Administer
activated charcoal at 1 gm/kg (usual adult dose 60-90 g,
child dose 25-50 g)
Antidotes and Other Treatments
Contact a medical toxicologist or a
regional poison control center for assistance in evaluating
the anion and osmolar gaps, and to decide whether antidotal
therapy, intravenous sodium bicarbonate, or hemodialysis is
needed.
In severe poisoning by ingestion,
prompt administration of ethanol or another blocking agent
(e.g., 4-methylpryrazole) prevents further metabolism of
ethylene glycol. Rapid treatment with a blocking agent is
very important; do not wait for symptoms to appear before
treatment. Time elapsed between ingestion and treatment and
the dose ingested are major factors of fatality.
Administration of thiamine and
pyridoxine may aid metabolism of ethylene glycol to nontoxic
products, but these compounds are less effective that
ethanol or 4-methylpyrazole. Hemodialysis is indicated in
cases of severe acidosis and/or renal dysfunction.
By competing with ethylene glycol as a
substrate for alcohol dehydrogenase, ethanol inhibits the
formation of toxic ethylene glycol metabolites. A medical
toxicologist or the poison control center should be
contacted to determine the proper dosage, which depends on
many factors (e.g., age, degree of alcohol use by the
victim, and effect on blood sugar). In general, the optimal
blood ethanol level is 100 to 150 mg/dL; this level should
be attained quickly by administering 10% ethanol
intravenously over 30 to 60 minutes.
Alternatively, ethanol can be
administered orally with a 20% ethanol solution until a
blood ethanol level of 100 to 150 mg/dL is reached.
Patients previously treated with ipecac/charcoal cannot
tolerate oral loading. The dosage must be adjusted if
the patient is undergoing hemodialysis. Repeatedly monitor
blood ethanol and glucose levels, as under dosing and
overdosing of ethanol regularly occur; this can lead to
hypoglycemia, especially in children.
An alternative to ethanol that also
inhibits the action of alcohol dehydrogenase on ethylene
glycol has recently become available in the United States.
This drug, 4-methylpyrazole, has low toxicity and is easier
to administer than ethanol. It is available as fomepizole
(Antizol) in packages of 1.5 mL vials (concentration = 1 g/1
mL). Each vial is diluted to 100 mL with sodium chloride.
Treatment consists of a 15-mg/kg loading dose followed in 12
hours by 10 mg/kg every 12 hours for four doses, then 15
mg/kg every 12 hours as long as indicated. Although
fomepizole has been less widely used than ethanol, its use
is rapidly increasing because of advantages over ethanol in
terms of its predictable pharmacokinetics, ease of
administration and lack of adverse effects.
Laboratory Tests
In all patients with known or suspected
ethylene glycol poisoning, blood tests should be performed
to measure blood glucose, serum electrolyte, calcium, BUN,
creatinine, ethylene glycol, and ethanol levels. ABG levels
and osmolarity should also be measured. These tests should
be repeated as necessary to closely monitor the progression
of toxic effects. Expected values depend on the time elapsed
since the ingestion of ethylene glycol, so this must be
considered in interpreting laboratory results.
Methanol levels should be measured in
patients with elevated anion and osmolar gaps. Other
conditions that can elevate anion and osmolar gaps include
methanol poisoning and diabetic ketoacidosis.
Traditionally, a serum ethylene glycol
level greater than 50 mg/dL has been associated with
significant toxicity. Nevertheless, although the
toxicokinetics are not well known, if enough time has passed
for metabolism to toxic metabolites to occur, significant
poisoning can be present when serum ethylene glycol levels
are less than 50 mg/dL.
Chest radiography and pulse oximetry
(or ABG measurements) are recommended for patients with
respiratory complaints.
A cardiac monitor should be placed to
look for QT prolongation, an indication of hypocalcemia.
Calcium oxalate crystals can be seen on
microscopic examination of the urine, but their absence does
not preclude ethylene glycol poisoning. A Woods (UV) lamp
test of the urine detects the fluorescent compound,
fluorescein, which is commonly added as a coloring agent to
automotive antifreezes. Urine fluorescence cannot be relied
upon to diagnose the presence or absence of ethylene glycol
ingestion. If present, it supports the diagnosis.
Disposition and Follow-up
All patients with ethylene glycol
poisoning should be evaluated and treated without delay.
Even patients with no or mild symptoms should undergo
appropriate blood and urine tests if they have a history of
significant ingestion. Patients requiring ethanol infusions,
4-methylpyrazole, or hemodialysis should be admitted to an
intensive care unit.
Delayed Effects
Renal effects typically take 24 to 72
hours to develop. Hemodialysis to treat acute renal failure
is essential.
Patient Release
Patients who have no history suggestive
of significant exposure and who have no symptoms or
laboratory findings of ethylene glycol poisoning may be
discharged with instructions to seek medical care promptly
if symptoms develop (see the Ethylene Glycol-Patient
Information Sheet
below).
Follow-up
Obtain the name of the patient's
primary care physician so that the hospital can send a copy
of the ED visit to the patient's doctor.
In cases of severe exposure, follow-up
laboratory evaluation of renal function should be arranged
and neurologic examination for post-hypoxic or oxalate
crystal injury is recommended.
Patients who have corneal lesions
should be re-examined within 24 hours.
Reporting
If a work-related incident has
occurred, you may be legally required to file a report;
contact your state or local health department.
Other persons might still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company
personnel might prevent future incidents. If a public health
risk exists, notify your state or local health department or
other responsible public agency. When appropriate, inform
patients that they may request an evaluation of their
workplace from OSHA or NIOSH. See Appendices III and IV for
a list of agencies that may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
ethylene glycol.
Print this handout only.pdf icon[PDF - 29.9 KB]
What is ethylene glycol?
Ethylene glycol is a colorless, syrupy
liquid used in antifreeze solutions and as a solvent in
making certain chemicals. When used in antifreeze solutions,
it is usually mixed with a fluorescent yellow dye to create
a bright yellow color. Ethylene glycol is odorless and can
have a sweet taste.
What immediate health effects can result from ethylene glycol exposure?
Drinking even small amounts (from 1 to
3 ounces) of ethylene glycol can result in damage to the
kidneys if the poisoning is not treated. Consumption of
larger quantities can be fatal. Skin contact with liquid
ethylene glycol or breathing low levels of vapors in the air
is generally not harmful or causes only minor irritation.
Very few individuals develop an allergic rash when the
liquid is on their skin.
Can ethylene glycol poisoning be treated?
Persons who have swallowed large
amounts of ethylene glycol should be hospitalized. In severe
exposures, special antidotes and hemodialysis might be
needed. Treatment is generally successful if begun within 3
hours of swallowing, and most people recover completely
after treatment.
Are any future health effects likely to occur?
Kidney damage is the most common effect
if severe exposure by ingestion is not treated.
What tests can be done if a person has been exposed to ethylene glycol?
Ethylene glycol and its breakdown products can be measured in blood and urine. After significant exposure, diagnostic tests are needed to measure kidney function and the levels of the toxicant in the blood.
Where can more information about ethylene glycol be found?
More information about ethylene glycol
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your
doctor; or a clinic in your area that specializes in
occupational and environmental health. If the exposure
happened at work, you may wish to discuss it with your
employer, the Occupational Safety and Health Administration
(OSHA), or the National Institute for Occupational Safety
and Health (NIOSH). Ask the person who gave you this form
for help in locating these telephone numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[PDF - 29.9B]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms
within the next 24 hours, especially:
- headache, dizziness, or a feeling of intoxication
- nausea, vomiting, or abdominal cramps.
[ ] No follow-up appointment is
necessary unless you develop any of the symptoms listed
above.
[ ] Call for an appointment with
Dr.____ in the practice of ________.
When you call for your appointment,
please say that you were treated in the Emergency Department
at _________ Hospital by________and were advised to be seen
again in ____days.
[ ] Return to the Emergency
Department/Clinic on ____ (date) at _____ AM/PM for a
follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for
_____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your
stomach or have other effects.
[ ] Avoid taking the following
medications: ________________
[ ] You may continue taking the
following medication(s) that your doctor(s) prescribed for
you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.