oxalates and Poisoning

Topics: Alkalosis; Animals; Animals, Domestic; Calcium; Cattle; Digestive System; Horse Diseases; Horses; Hydrogen-Ion Concentration; Hypocalcemia; Oxalates; Plant Poisoning; Poisoning; Rumen; Sheep; Sheep Diseases; Swine; Swine Diseases; Uremia; Water

Topics: Central Nervous System Diseases; Ethylenes; Glycols; Humans; Kidney Diseases; Lung Diseases; Oxalates; Poisoning; Propylene Glycols

Ethylene glycol poisoning causes metabolic acidosis and renal failure and may cause death. The standard treatment is inhibition of alcohol dehydrogenase with ethanol, given in intoxicating doses, and adjunctive hemodialysis. We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning.. We administered intravenous fomepizole to 19 patients with ethylene glycol poisoning (plasma ethylene glycol concentration, > or =20 mg per deciliter [3.2 mmol per liter]). Patients who met specific criteria also underwent hemodialysis. Treatment was continued until plasma ethylene glycol concentrations were less than 20 mg per deciliter. Acid-base status, renal function, the kinetics of fomepizole, and ethylene glycol metabolism were assessed at predetermined intervals.. Fifteen of the patients initially had acidosis (mean serum bicarbonate concentration, 12.9 mmol per liter). Acid-base status tended to normalize within hours after the initiation of treatment with fomepizole. One patient with extreme acidosis died. In nine patients, renal function decreased during therapy; at enrollment, all nine had high serum creatinine concentrations and markedly elevated plasma glycolate concentrations (> or =97.7 mg per deciliter [12.9 mmol per liter]). None of the 10 patients with normal serum creatinine concentrations at enrollment had renal injury during treatment; all 10 had plasma glycolate concentrations at or below 76.8 mg per deciliter (10.1 mmol per liter). Renal injury was independent of the initial plasma ethylene glycol concentration. The plasma concentration of glycolate and the urinary excretion of oxalate, the major metabolites of ethylene glycol, uniformly fell after the initiation of fomepizole therapy. Few adverse effects were attributable to fomepizole.. In patients with ethylene glycol poisoning, fomepizole administered early in the course of intoxication prevents renal injury by inhibiting the formation of toxic metabolites.

Topics: Adult; Aged; Antidotes; Ethylene Glycol; Female; Fomepizole; Glycolates; Humans; Keratolytic Agents; Kidney Diseases; Male; Middle Aged; Oxalates; Poisoning; Prospective Studies; Pyrazoles; Treatment Outcome

Fomepizole is the antidote of choice in toxic alcohol poisonings. Potential side effects from frequent use of fomepizole were studied in a patient admitted 154 times with ethylene glycol (EG) poisoning. The intra-individual correlation between the serum-ethylene glycol (serum-EG) and the osmolal gap (OG) EG-kinetics, and other laboratory parameters were also studied.. Combined pro- and retrospective collection of material from three different hospitals, and results from autopsy.. A 26-year-old female with a dissociative disorder was admitted with EG poisoning a total of 154 times. Her admission data revealed a median pH of 7.31 (range 6.87-7.49), pCO(2): 4.2 kPa (1.2-6.7) (32 mmHg [9-50]), HCO-3: 15 mmol/L (4-26) (15 mEq/L [4-26]), base deficit (BD): 10 mmol/L (- 4 to 27) (10 mEq/L [-4 to 27]), serum-creatinine 65 μmol/L (40-133) (0.74 mg/dL [0.45-1.51]), OG 81 mOsm/kgH(2)O (25-132), and serum-EG 44 mmol/L (4-112) (250 mg/dL [25-700]). She was treated with fomepizole 99 times, ethanol 60 times (with a combination of both six times), and dialysis 73 times. The correlation between serum-EG and OG was good (r(2) = 0.76). She was finally found dead outside hospital with an EG blood concentration of 81 mmol/L (506 mg/dL). An autopsy revealed calcium oxalate crystals in the kidneys, slight liver steatosis, and slight edema of the lungs.. The frequent use of fomepizole in this young patient was not associated with any detectable side effects; neither on clinical examination and lab screening, nor on the later autopsy. Regarding the sequelae from the repetitive EG-poisoning episodes, her kidney function seemed to normalize after each overdose. She was treated with buffer and antidote without hemodialysis 81 times without complications, supporting the safety of this approach in selected cases.

Topics: Adult; Antidotes; Dissociative Disorders; Ethylene Glycol; Female; Fomepizole; Glycolates; Half-Life; Humans; Hyperkalemia; Kidney; Liver; Oxalates; Poisoning; Pyrazoles; Recurrence; Renal Dialysis; Suicide

Ethylene glycol (EG), a relatively infrequent cause of fatal intoxication, presents an analytical challenge for forensic confirmation in postmortem toxicology. We report EG and glycolic acid (GA) quantification in postmortem blood by gas chromatography coupled with ion trap mass spectrometry (GC-MS) analysis using a modification of a previously reported clinical method. The method is linear from 50 to 4000 mg/L with a limit of detection of 25 mg/L for both EG and GA. Interassay coefficient of variation (2.1-8.6%, 4.3-6.0%) and accuracy (96-101%, 92-105%) were determined for EG and GA, respectively. EG concentration by ion trap GC-MS correlated closely (R(2) = 0.995) with EG quantified by GC-flame-ionization detection. Analysis of blood from 20 autopsies with no evidence of EG exposure did not reveal detectable EG or GA. In 12 medical examiner cases with EG poisoning as cause of death, EG concentrations ranged widely from 58 to 7790 mg/L with a mean of 1830 mg/L, and the GA concentration averaged 1360 mg/L with a narrower range of 810-1770 mg/L. EG and GA levels correlate poorly (R(2) = 0.15) in postmortem blood with discordantly low EG concentrations in two cases. Birefringent oxylate crystals in renal tissue was a consistent finding. In conclusion, a sensitive and specific GC-MS method for detection and quantification of EG and GA has been validated and a study of fatal EG poisonings revealed forensic application of the method.

Topics: Birefringence; Cause of Death; Ethylene Glycol; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Glycolates; Humans; Kidney; Microscopy, Polarization; Oxalates; Poison Control Centers; Poisoning; Reproducibility of Results; Spectrometry, Mass, Electrospray Ionization; Tandem Mass Spectrometry

Topics: Crystallization; Ethylene Glycol; Ethylene Glycols; Humans; Methanol; Oxalates; Poisoning

Topics: Acetaminophen; Acids; Antidotes; Aspirin; Barbiturates; Carbon Tetrachloride Poisoning; Child; Child, Preschool; Digitalis Glycosides; Emetics; Gastric Lavage; Household Products; Humans; Hypnotics and Sedatives; Infant; Insecticides; Lye; Metals; Morphine; Oxalates; Plant Poisoning; Poisoning; Renal Dialysis; Rodenticides; Tranquilizing Agents

Topics: Acids; Humans; Hydrofluoric Acid; Oxalates; Poisoning

Topics: Acidosis; Acute Kidney Injury; Adult; Aldehydes; Blood Urea Nitrogen; Brain; Brain Diseases; Ethylenes; Glycols; Glyoxylates; Heart Failure; Humans; Lung Diseases; Male; Oxalates; Poisoning

Topics: Acidosis; Adult; Aged; Alcoholism; Bicarbonates; Coma; Dialysis; Ethylenes; Female; Glycols; Humans; Intubation; Male; Mental Disorders; Oxalates; Poisoning; Respiration, Artificial; Tromethamine

Topics: Acid-Base Equilibrium; Acute Disease; Aged; Anuria; Autopsy; Brain; Calcium; Dehydration; Glycols; Humans; Hydrogen-Ion Concentration; Kidney Tubules; Male; Oxalates; Peritoneal Dialysis; Poisoning

Topics: Animal Feed; Animals; Aspergillus; Female; Horse Diseases; Horses; Kidney; Nephrosclerosis; Oxalates; Poisoning

Topics: Animals; Bicarbonates; Calcium; Crystallization; Ethanol; Glycols; Kidney; Male; Microscopy, Polarization; Oxalates; Poisoning; Rats; Sodium

Topics: Animals; Calcium; Dogs; Glycols; Kidney; Kidney Tubules; Oxalates; Poisoning

Topics: Animals; Brain; Carnivora; Cat Diseases; Cats; Dog Diseases; Dogs; Ethylene Glycols; Glycols; Nephritis; Neurologic Manifestations; Oxalates; Pathology; Poisoning; Toxicology

Topics: Ammonium Compounds; Anticoagulants; Caustics; Cholinesterase Inhibitors; Clinical Laboratory Techniques; Enzyme Inhibitors; Fluorides; Fluorine; Humans; Laboratories; Martinique; Oxalates; Pathology; Poisoning; Quaternary Ammonium Compounds; Suicide; Tetany; Toxicology; West Indies

Topics: Acetone; Alcohols; Carbon Tetrachloride; Child; Detergents; Humans; Infant; Insecticides; Oxalates; Paint; Pesticides; Petroleum; Poisoning; Toxicology; Turpentine

Topics: Adolescent; Fluoride Poisoning; Fluorides; Guinea Pigs; Household Products; Oxalates; Oxalic Acid; Pathology; Poisoning; Research; Suicide; Toxicology

Topics: Humans; Hyperoxaluria; Lacrimal Apparatus; Oculomotor Muscles; Ophthalmology; Optic Nerve; Oxalates; Poisoning; Toxicology

Topics: Blood; Calcium; Calcium, Dietary; Humans; Magnesium; Oxalates; Oxalic Acid; Poisoning; Water-Electrolyte Balance