Nephrotoxic effects of diethylene glycol (DEG) in rats

Pre-existing liver cirrhosis reduced the toxic effect of diethylene glycol in a rat model due to the impaired hepatic alcohol dehydrogenase

Hepatic metabolizing enzymes of diethylene glycol (DEG) are impaired in liver diseases. Thus, the purpose of this study was to increase our understandings in metabolism and toxicology of DEG by clarifying the influences of pre-existing liver disease. Forty Sprague-Dawley rats with carbon tetrachloride-induced liver cirrhosis and 20 control rats were intraperitoneally administered a single dose of DEG, and randomly killed 1, 2, 5 or 8 days following exposure. Compared with control rats, the model rats had significantly higher blood CO(2)-combining power, lower blood urine nitrogen, serum creatinine and alanine aminotransferase levels on the second day and a lower mortality rate on the eighth day following DEG exposure. Enlargements of liver and kidneys and degeneration and necrosis of hepatocytes and renal tubules in the model rats was also less serious than in the control rats. Urine DEG levels were significantly higher on the first day in the model rats than the control rats (46.65 ± 8.79 mg vs 18.88 ± 6.18 mg, p < 0.01), but DEG concentrations in the blood, liver and kidneys were lower. Hepatic alcohol dehydrogenase (ADH) activity in the model rats was significantly lower than that in the control rats, which was positively related to renal damage. The toxic effects of DEG in rats with pre-existing liver cirrhosis are significantly reduced, which may be due to the decreased hepatic ADH activity. It suggests that the metabolite of ADH is responsible for DEG poisoning, and this toxic metabolite may mainly originate in the liver.

Venous diethylene glycol poisoning in patients with preexisting severe liver disease in China

AIM: To analyze the clinical presentation of venous diethylene glycol (DEG) poisoning in patients with preexisting severe liver disease and factors that correlate with DEG poisoning.

METHODS: Retrospective chart review was performed to analyze the epidemiology, clinical presentation, hepatorenal functions, hemodynamics and pathological characteristics of 64 patients with severe liver disease who received intravenous armillarisin-A, the solvent of which was DEG. Comparative analyses of correlating factors and causes for poisoning were based on the presence or absence of poisoning.

RESULTS: Of the 64 patients who received armillarisin-A, 15 were found to have DEG poisoning. Twelve poisoned patients died. After a mean of 5 d, the poisoned patients displayed acute renal failure. Metabolic acidosis occurred in 13 cases. BUN, Cr, and CO₂ values were significantly elevated and exacerbation of digestive tract symptoms and/or symptom was noted in 11 cases. Neurological system impairment was observed in 10 cases after 2 wk. Compared to the 49 non-poisoned patients, the poisoned patients exhibited significantly lower RBC and Hb values and higher WBC count. Renal biopsy from the poisoned patients revealed acute tubular necrosis and interstitial nephritis. Significant differences in preexisting severe hepatitis, ascites, renal disease, and diuretic therapy were found between groups. Prior to diethylene glycol injections, the mean values for neutral granular cells, BUN, Cr, calcium and phosphorous ions differed significantly between groups.

CONCLUSION: Venous diethylene glycol poisoning is characterized by oliguric acute renal failure, metabolic acidosis, digestive symptoms, nervous system impairment, and a high probability of anemia and WBC proliferation. Mortality is high. Correlative factors include preexisting severe liver disease, renal disease, and infection.

Toxic alcohol ingestions: clinical features, diagnosis, and management

Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.

Developmental toxicity study with diethylene glycol dosed by gavage to CD rats and CD-1 mice

Diethylene glycol (DEG; CAS Number 111-46-6) is a widely used industrial liquid chemical with a potential for human exposure. In view of the established teratogenic effects caused by ethylene glycol in laboratory animals, the developmental toxicity of DEG was investigated in mice and rats, species known to be sensitive to the developmental toxicity of ethylene glycol. Timed-pregnant CD-1 mice and CD rats were dosed daily by gavage with undiluted DEG over gestational days (gd) 6-15. Based on probe studies, mouse dosages were 0 (distilled water), 559, 2795 and 11,180 mg/kg/day, and those for rats 0, 1118, 4472 and 8944 mg/kg/day. They were examined daily for clinical signs of toxicity, and body weights, food consumption and water consumption measured periodically throughout gestation. At necropsy, on gd 18 (mice) or gd 21 (rats), dams were examined for gross pathology and body, gravid uterus, liver and kidney weights were measured. Maternal rat kidneys were examined histologically. Fetuses were weighed, sex determined, and examined for external, visceral and skeletal variations and malformations. With mice there was maternal toxicity at 11,180 mg/kg/day (mortality, signs, increased water consumption) and at 2795 mg/kg/day (increased water consumption). Implantations were comparable across all groups. Fetal body weights were significantly reduced at 11,180 mg/kg/day. There were no increases in variations or malformations, either total, by category, or individually. With rats, maternal toxicity was present at 8944 mg/kg/day (mortality, signs, reduced body weight gain, reduced food consumption, increased water consumption, increased liver weight, increased kidney weight, and renal histopathology), and 4472 mg/kg/day (increased water consumption). There were no treatment-related effects on corpora lutea or implantations. Fetal body weights were reduced at 8944 mg/kg/day. There were no significant effects with respect to total or individual external or visceral variations. Individual skeletal variations were significantly increased at 8944 mg/kg/day (poorly ossified interparietal, poorly ossified thoracic centra number 10 and number 13, and bilobed thoracic centrum number 10) and 4472 mg/kg/day (split anterior arch of atlas and bilobed thoracic centrum number 10). This pattern of delayed ossification is consistent with reduced fetal body weight. Malformations, total, by category, or individually, were similar between the control and DEG groups. Thus, under the conditions of these studies, the no-observed-effect-level (NOEL) for DEG given by gavage over gd 6-15 was 559 mg/kg/day with the mouse and 1118 mg/kg/day with the rat for maternal toxicity, and 2795 mg/kg/day with mice and 1118 mg/kg/day with rats for developmental toxicity (fetotoxicity). There were no indications of embryotoxicity or teratogenic effects at any dosage in either species.

Ethylene glycol poisoning: case report of a record-high level and a review

Ethylene glycol is commonly found in automobile antifreeze and a variety of other commercial products. Ingestion of ethylene glycol, either accidentally or in a suicide attempt, is characterized by severe acidosis, calcium oxalate crystal formation and deposition, and a wide variety of end organ effects that may be fatal. We present a case of a patient who ingested a massive amount of ethylene glycol in a suicide attempt and yet survived with minimal sequelae. A comprehensive review of the literature on the pathology and pathophysiology of ethylene glycol toxicity on each organ system is provided, along with information on diagnosis and current treatment recommendations.

Kidney function in rats after 5/6 nephrectomy (5/6 NX); effort of treatment with vitamin E

In adult female rats various kidney functions were measured 3 weeks after 5/6 nephrectomy (5/6 NX). The distinct rises in blood urea nitrogen and in renal excretion of proteins indicate the impairment of the kidney. In 5/6 NX rats, the renal excretion of creatinine, glucosaminoglycan, and of p-aminohippurate was diminished. The concentrations of hydroxypyroline and of free hydrogen ions were distinctly increased in urine samples from 5/6 NX rats. The concentration of lipid peroxides was enhanced in kidney tissue whereas 3 weeks after 5/6 NX the concentration of GSH and GSSG in the remnant kidney tissue was unchanged. Long-term administration of vitamin E increased its concentration in plasma, kidney, and liver. Nevertheless, daily treatment with vitamin E (1 or 10 mg/100 g b.w. s.c. for 5 weeks) did not reduce the degree of impairment of kidney function following 5/6 NX.

Glutathione status, lipid peroxidation and kidney function in streptozotocin diabetic rats

In adult female rats diabetic nephropathy was induced by i.v. administration of streptozotocin (6 mg/100 g b.w.). The animals survive for 3 weeks when very low daily doses of insulin (0.3 IU/animal) are administered. High blood urea concentrations and distinct proteinuria indicate the impairment of kidney function in streptozotocin diabetic rats. Streptozotocin induces mild polyuria and increased renal excretion of potassium; there is also an increase in renal excretion of administered p-aminohippurate. Three weeks after administration of streptozotocin the formation of lipid peroxides is increased in the kidney. At this time glutathione content (GSH, GSSG) is unchanged in liver and kidney of streptozotocin diabetic rats. Impairment of kidney function in streptozotocin diabetic rats can be prevented by daily supplementation with sufficient doses of insulin (about 3 IU/animal).