Lack of efflux of diglycolic acid from proximal tubule cells leads to its accumulation and to toxicity of diethylene glycol

Rapid Determination of Trace Ethylene Glycol and Diethylene Glycol in Propylene Glycol-Contained Syrups by Ultrahigh-Performance Supercritical Fluid Chromatography-Mass Spectrometry after Precolumn Derivatization

Ethylene glycol (EG) and diethylene glycol (DEG) are two contaminants known to cause a variety of human health problems, when ingested in certain amounts, they can cause adverse effects such as nephrotoxicity, neurotoxicity and even death. They are widely found in propylene glycol, which is commonly used as a base for pharmaceutical syrups. The aim of this study was to develop an analytical method for the evaluation of EG and DEG in commercially available pediatric syrups. In this study, a fast, simple and reliable ultrahigh performance supercritical fluid chromatography-electrospray ionization-mass spectrometry (UHPSFC-ESI-MS) method was developed. The work involved the evaluation of three derivatization reagents for UHPSFC-ESI-MS. Benzoyl chloride was finally selected as the optimal derivatization reagent. Compared with an approach without derivatization, the present method achieved the separation and detection of EG and DEG efficiently, sensitively and rapidly, and analysis of EG and DEG in syrup formulations was realized within 7 min. The linear determination coefficients of EG and DEG in the concentration range of 0.25-25.0 μg/mL were greater than 0.999. The limits of detection for EG and DEG were 0.02 μg/mL and 0.07 μg/mL, respectively, and the limits of quantification were 0.09 μg/mL and 0.25 μg/mL, respectively. The recovery rates of DEG and EG ranged from 85.5%-108.1% and 86.7%-117.2%, respectively. The absolute values of the matrix effects in the three types of syrups considered were all less than 10%. Meanwhile, a gas chromatography-hydrogen flame ionization detection method was established for cross-testing of the analytical results. In 10 batches of syrup formulations, DEG was not detected by either method. The presence of EG was detected by UHPSFC-ESI-MS in only three batches, none of which exceeded 90.23 parts per million (ppm), with a mean absolute error of 5.95 ppm between the two sets of results. The developed UHPSFC-ESI-MS method was rapid, simple, efficient, sensitive and accurate for the determination of EG and DEG in genuine syrup formulations.

Thrombotic Microangiopathy and Acute Tubular Injury After Diethylene Glycol Ingestion: A Kidney Biopsy Teaching Case

We present a rare and unusual case of thrombotic microangiopathy (TMA) in a patient who ingested chafing fuel containing diethylene glycol. The patient showed a typical clinical course of initial gastrointestinal symptoms followed by acute kidney injury (AKI) and peripheral sensorimotor neuropathy. A kidney biopsy showed TMA and diffuse acute tubular injury. Diethylene glycol is widely used as a solvent in numerous consumer products, including brake fluid, antifreeze, chafing fuel, and artificial fog solutions. Diethylene glycol has been implemented in mass poisonings, and the incidence of AKI in diethylene glycol poisonings is linked to high-mortality rates. TMA, a pathologic lesion observed in a wide spectrum of diseases, is triggered by endothelial injury. Our case shows that TMA should be considered as a possible life-threatening complication in the setting of acute diethylene glycol poisoning. Direct toxic injury to endothelial cells by diethylene glycol is a possible mechanism. It is therefore plausible that patients with a genetic predisposition to endothelial injury may develop TMA following diethylene glycol exposure.