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Qu X, Li M, Mu H, Jin B, Song M, Zhang K, Wu Y, Li L, Yu Y. Facile Fabrication of Lilac-Like Multiple Self-Supporting WO 3 Nanoneedle Arrays with Cubic/Hexagonal Phase Junctions for Highly Sensitive Ethylene Glycol Gas Sensors. ACS Sens 2024; 9:3604-3615. [PMID: 39016238 DOI: 10.1021/acssensors.4c00600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Metal oxides with nanoarray structures have been demonstrated to be prospective materials for the design of gas sensors with high sensitivity. In this work, the WO3 nanoneedle array structures were synthesized by a one-step hydrothermal method and subsequent calcination. It was demonstrated that the calcination of the sample at 400 °C facilitated the construction of lilac-like multiple self-supporting WO3 arrays, with appropriate c/h-WO3 heterophase junction and highly oriented nanoneedles. Sensors with this structure exhibited the highest sensitivity (2305) to 100 ppm ethylene glycol at 160 °C and outstanding selectivity. The enhanced ethylene glycol gas sensing can be attributed to the abundant transport channels and active sites provided by this unique structure. In addition, the more oxygen adsorption caused by the heterophase junction and the aggregation of reaction medium induced by tip effect are both in favor of the improvement on the gas sensing performance.
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Affiliation(s)
- Xiaohan Qu
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Mingchun Li
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Hanlin Mu
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Bingbing Jin
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Minggao Song
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Kunlong Zhang
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Yusheng Wu
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Laishi Li
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Yan Yu
- College of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
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2
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Yoshioka T, Koyanagi M, Yoshida N. Real-world safety and effectiveness of intravenous fomepizole in patients with ethylene glycol and methanol poisoning in Japan: results of a 7-year post-marketing surveillance study. Expert Opin Drug Saf 2024:1-9. [PMID: 38932699 DOI: 10.1080/14740338.2024.2372410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Fomepizole is a competitive alcohol dehydrogenase inhibitor used for the treatment of ethylene glycol and methanol poisoning. We evaluated the safety and effectiveness of fomepizole in patients with ethylene glycol or methanol poisoning in Japan. RESEARCH DESIGN AND METHODS This retrospective post-marketing surveillance study conducted in Japan registered patients who received fomepizole intravenous infusion per the package insert (January 2015-June 2022). Endpoints included adverse drug reactions/infections (ADRs), arterial blood pH, and treatment outcomes. RESULTS Of 147 patients registered (91 institutions), 131 and 126 were included in the safety and effectiveness analysis sets, respectively. Mean age was 43.6 years, and 66.4% were male. Mean time from poison ingestion to treatment was 15.1 hours; 66.4% received concomitant hemodialysis. No serious ADRs were reported. ADRs were reported in seven patients; the most-reported ADR was vomiting (2.3%). Seven patients died, 105 survived without sequelae, and 19 survived with sequelae. Most common sequelae were renal failure or renal dysfunction. Mean arterial blood pH increased to 7.4 by 4 hours of treatment, remaining stable for 24 hours post-treatment. CONCLUSIONS Fomepizole is well tolerated and helps improve clinical outcomes in patients with ethylene glycol or methanol poisoning in Japan. TRIAL REGISTRATION Japanese Pharmaceutical Information Center (JapicCTI-152817).
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Affiliation(s)
- Toshiharu Yoshioka
- Vice-President, Morinomiya University of Medical Sciences, Osaka, Japan
- Representative Director, Japan Poison Information Center, Osaka, Japan
| | - Momoha Koyanagi
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Naoki Yoshida
- Statistical and Quantitative Sciences, Data Sciences Institute, Research & Development, Takeda Pharmaceutical Company Limited, Osaka, Japan
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3
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Radke S, Finley E. Industrial and Agricultural Toxicants. Vet Clin North Am Equine Pract 2024; 40:167-178. [PMID: 37968203 DOI: 10.1016/j.cveq.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
This article provides an overview of several agricultural and industrial toxicants that are most likely to be encountered by horses. Overviews include brief backgrounds of the agents in question, potential sources of intoxication, mechanisms of action, clinical signs, lesions, diagnostic considerations, and treatment options.
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Affiliation(s)
- Scott Radke
- Iowa State University College of Veterinary Medicine, Veterinary Diagnostic and Production Animal Medicine, 1850 Christensen Drive, Ames, IA 50011, USA.
| | - Emily Finley
- Iowa State University College of Veterinary Medicine, Veterinary Diagnostic and Production Animal Medicine, 1850 Christensen Drive, Ames, IA 50011, USA
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4
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Leonard JB, Minhaj FS, Erickson K, King J. Fomepizole use reported to United States Poison Centers from 2010 to 2021. Clin Toxicol (Phila) 2024; 62:120-125. [PMID: 38465690 DOI: 10.1080/15563650.2024.2319863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The diagnosis of toxic alcohol poisoning is often based on clinical presentation and nonspecific surrogate laboratory studies due to limited testing availability. Fomepizole is the recommended antidote and often administered empirically. The objective of this study is to identify substances that mimic toxic alcohols and compare key clinical factors between toxic alcohol and non-toxic alcohol exposures when fomepizole was administered. METHODS This study was a retrospective evaluation using the National Poison Data System from January 1, 2010 through December 31, 2021. Exposures were included if fomepizole was administered. Toxic alcohol exposures had ethylene glycol or methanol as a coded substance. For exposures not coded as a toxic alcohol, the first substance was described. Paracetamol (acetaminophen) exposures from 2020 and 2021 were excluded. RESULTS Fomepizole was reportedly used 25,110 times over 12 years. Use increased from 1,955 in 2010 to 2,710 in 2021. Most administrations were for reported toxic alcohol poisoning (60 percent) but use in reported non-toxic alcohol poisoning was greater starting in 2020. Toxic alcohol exposures were older (43.3 versus 39.8 years; P < 0.001) and more likely male (65.7 percent versus 58.2 percent). Level of care was mostly a critical care unit (67.7 percent), which was less common in toxic alcohol (63.3 percent) than non-toxic alcohol exposures (74.2 percent). The most common non-toxic alcohol substances were ethanol (24.9 percent) or an unknown drug (17.5 percent). Acidosis, increased creatinine concentration, anion gap, and osmolal gap, and kidney failure were coded in a lower proportion of toxic alcohol exposures than non-toxic alcohol exposures (P < 0.001). DISCUSSION The inability to provide rapid clinical confirmation of toxic alcohol poisoning results in the empiric administration of fomepizole to many patients who will ultimately have other diagnoses. Although fomepizole is relative well tolerated we estimated that this practice costs between $1.5 to $2.5 million. The major limitations of this work include the biases associated with retrospective record review, and the inability to confirm the exposures which may have resulted in allocation error. CONCLUSION Most fomepizole use was for a presumed toxic alcohol. This recently shifted to greater use in likely non-toxic alcohol poisoning. Key difference between the groups suggest fomepizole administration was likely due to the difficulty in diagnosis of toxic alcohol poisoning along with the efficacy and safety of fomepizole. Increased toxic alcohol laboratory testing availability could improve timely diagnosis, reserving fomepizole use for toxic alcohol poisoning.
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Affiliation(s)
- James B Leonard
- Maryland Poison Center, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Kennedy Erickson
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Joshua King
- Maryland Poison Center, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
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5
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Filip AB, Farnsworth CW, Mullins ME, Crews BO, Kraut JA. Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection. J Med Toxicol 2023; 19:362-367. [PMID: 37695470 PMCID: PMC10522546 DOI: 10.1007/s13181-023-00967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG. METHODS This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay. RESULTS Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were "positive." At the manufacturer's threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7-100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of -5.3 (-8.9 to -1.7). CONCLUSIONS The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.
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Affiliation(s)
- Ari B Filip
- Arkansas Poison and Drug Information Center, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA.
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bridgit O Crews
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey A Kraut
- Medical and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA; UCLA Membrane Biology Laboratory, Division of Nephrology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Abstract
Oxalate homeostasis is maintained through a delicate balance between endogenous sources, exogenous supply and excretion from the body. Novel studies have shed light on the essential roles of metabolic pathways, the microbiome, epithelial oxalate transporters, and adequate oxalate excretion to maintain oxalate homeostasis. In patients with primary or secondary hyperoxaluria, nephrolithiasis, acute or chronic oxalate nephropathy, or chronic kidney disease irrespective of aetiology, one or more of these elements are disrupted. The consequent impairment in oxalate homeostasis can trigger localized and systemic inflammation, progressive kidney disease and cardiovascular complications, including sudden cardiac death. Although kidney replacement therapy is the standard method for controlling elevated plasma oxalate concentrations in patients with kidney failure requiring dialysis, more research is needed to define effective elimination strategies at earlier stages of kidney disease. Beyond well-known interventions (such as dietary modifications), novel therapeutics (such as small interfering RNA gene silencers, recombinant oxalate-degrading enzymes and oxalate-degrading bacterial strains) hold promise to improve the outlook of patients with oxalate-related diseases. In addition, experimental evidence suggests that anti-inflammatory medications might represent another approach to mitigating or resolving oxalate-induced conditions.
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Affiliation(s)
- Theresa Ermer
- Department of Surgery, Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Lama Nazzal
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Maria Clarissa Tio
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sushrut Waikar
- Department of Medicine, Section of Nephrology, Boston University, Boston, MA, USA
| | - Peter S Aronson
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT, USA.
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Martinez Manzano JM, Elkholy KO, Lo KB. Brain MRI abnormalities in acute ethylene glycol poisoning: a case report. TOXICOLOGY COMMUNICATIONS 2022. [DOI: 10.1080/24734306.2022.2087019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jose Manuel Martinez Manzano
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karim O. Elkholy
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Stašinskis R, Stašinska K, Mukāns M, Graudiņš A, Liguts V, Lejnieks A. Changes in ionized calcium in ethylene glycol poisoning. Proc AMIA Symp 2022; 35:460-465. [DOI: 10.1080/08998280.2022.2062550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Roberts Stašinskis
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
| | | | | | - Andis Graudiņš
- Riga Stradins University, Riga, Latvia
- Monash Health at Monash University, Melbourne, Australia
| | - Viesturs Liguts
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
| | - Aivars Lejnieks
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
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Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, Teresiński G, Buszewicz G, Januszewski J, Flieger J. Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053092. [PMID: 35270784 PMCID: PMC8910489 DOI: 10.3390/ijerph19053092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.
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Affiliation(s)
- Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
- Correspondence:
| | - Joanna Kobak
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Magdalena Tyczyńska
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Iga Dudek
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Amr Maani
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Grzegorz Buszewicz
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jacek Januszewski
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland;
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Sommerfeld-Klatta K, Łukasik-Głębocka M, Zielińska-Psuja B. Oxidative stress and biochemical indicators in blood of patients addicted to alcohol treated for acute ethylene glycol poisoning. Hum Exp Toxicol 2022; 41:9603271211061502. [PMID: 35023765 DOI: 10.1177/09603271211061502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ethylene glycol (EG), in addition to its neurotoxic and nephrotoxic effects, evokes oxidative stress. The aim of this study was to assess the influence of the ethylene glycol on the biochemical indicators and oxidoreductive balance of patients treated for acute poisoning. The total study group consisted of 56 persons including 26 alcoholics who took EG as a substitute for ethyl alcohol in the course of alcohol dependence syndrome and 30 controls. Severity of poisoning, results of acid-base parameters, biochemical, and toxicological tests as well as biomarkers of the oxidative stress in blood were analyzed during the patients' hospitalization. The key issue was to assess the oxidative stress and biochemical disturbances caused by EG and the type of treatment applied in the course of poisoning. Significant changes in some parameters were found both at time of diagnosis and after treatment initiation (ethanol as an antidote and hemodialysis). The most important differences included the activity of hepatic parameters (aspartate aminotransferase, AST) and oxidative stress markers like catalase (CAT); correlation of the lipid peroxidation products level (TBARS) with urea concentration has been shown. On the last day of the hospitalization, in some cases, the mutual correlation between the evaluated markers were observed, for example, between alanine transaminase (ALT) and glutathione reductase (GR), and urea concentration and glutathione level (GSH/GSSG). The concentration of ions (H+) had a major impact on the oxidoreductive balance, correlating with the elevated GR and GSH/GSSG levels.
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Affiliation(s)
- Karina Sommerfeld-Klatta
- Department of Toxicology, Faculty of Pharmacy, 37807Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Łukasik-Głębocka
- Department of Emergency Medicine, Faculty of Health Sciences, 37807Poznań University of Medical Sciences, Poznań, Poland
| | - Barbara Zielińska-Psuja
- Department of Toxicology, Faculty of Pharmacy, 37807Poznań University of Medical Sciences, Poznań, Poland
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Bodo E, Merlo S, Bello V. Spectral Fingerprint Investigation in the near Infra-Red to Distinguish Harmful Ethylene Glycol from Isopropanol in a Microchannel. SENSORS 2022; 22:s22020459. [PMID: 35062420 PMCID: PMC8781737 DOI: 10.3390/s22020459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
Ethylene glycol (EG) and isopropanol (ISO) are among the major toxic alcohols that pose a risk to human health. However, it is important to distinguish them, since EG is more prone to cause renal failure, and can thus be more dangerous when ingested than ISO. Analysis of alcohols such as isopropanol and ethylene glycol generally can be performed with a complex chromatographic method. Here, we present an optical method based on absorption spectroscopy, performed remotely on EG-ISO mixtures filling a microchannel. Mixtures of ethylene glycol in isopropanol at different volume concentrations were analyzed in a contactless manner in a rectangular-section glass micro-capillary provided with integrated reflectors. Fiber-coupled broadband light in the wavelength range 1.3–1.7 µm crossed the microchannel multiple times before being directed towards an optical spectrum analyzer. The induced zig-zag path increased the fluid–light interaction length and enhanced the effect of optical absorption. A sophisticated theoretical model was developed and the results of our simulations were in very good agreement with the results of the experimental spectral measurements. Moreover, from the acquired data, we retrieved a responsivity parameter, defined as power ratio at two wavelengths, that is linearly related to the EG concentration in the alcoholic mixtures.
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12
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Ukita K, Otomune K, Fujimoto R, Hasegawa K, Izumikawa K, Morimoto N, Sasaki K, Hirasaki A, Takaguchi K. Anion gap-opening metabolic acidosis and urinary findings in the early diagnosis of ethylene glycol poisoning: A case report. Clin Case Rep 2022; 10:e05215. [PMID: 35028142 PMCID: PMC8741873 DOI: 10.1002/ccr3.5215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Causative agent identification is important in the treatment of poisoning. We report the case of a patient who presented with an altered level of consciousness after drinking a fluorescent pink liquid. Upon measuring the anion gap and urinary calcium oxalate level, the patient was diagnosed with early ethylene glycol poisoning.
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Affiliation(s)
- Kentaro Ukita
- Postgraduate Clinical Training CenterKagawa Prefectural Central Hospital
| | - Kanako Otomune
- Department of Emergency MedicineKagawa Prefectural Central Hospital
| | - Ryo Fujimoto
- Postgraduate Clinical Training CenterKagawa Prefectural Central Hospital
| | - Kanako Hasegawa
- Postgraduate Clinical Training CenterKagawa Prefectural Central Hospital
| | - Koichi Izumikawa
- Department of General MedicineKagawa Prefectural Central Hospital
| | | | - Kazuhiro Sasaki
- Department of Emergency MedicineKagawa Prefectural Central Hospital
| | | | - Koichi Takaguchi
- Department of General MedicineKagawa Prefectural Central Hospital
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13
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Peloquin SK, Rotstein DS, Jones JL, Guag J, Carey L, Palmer LA, Wolf K, Burkholder W, Hodges A, Payne L, Reimschuessel R. Presumed Choline Chloride Toxicosis in Cats With Positive Ethylene Glycol Tests After Consuming a Recalled Cat Food. Top Companion Anim Med 2021; 44:100548. [PMID: 34044172 DOI: 10.1016/j.tcam.2021.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Four previously healthy adult domestic shorthair cats (2 male, 2 female) from one household developed acute vomiting and ataxia less than 12 hours after consuming a commercial canned cat food. Blood work abnormalities included mild hyperglycemia with increased alanine aminotransferase (n = 1) and decreased blood urea nitrogen (n = 2). The veterinarian conducted whole blood ethylene glycol (EG) tests, which were positive for all cats. There were no known EG exposures. All cats were treated for suspected EG toxicosis and fully recovered after 48 hours. Separately from the cats' case, the same food was voluntarily recalled by the manufacturer 5 days later due to a higher-than-formulated amount of choline chloride added to the food. The 4 cats' canned cat food was tested for choline, choline chloride, EG, diethylene glycol, and propylene glycol to look for causes of the positive whole blood EG test. The cat food contained an average of 165,300 ppm (165,300 mg/kg) choline and 221,600 ppm (221,600 mg/kg) choline chloride on a dry matter basis, which is at least 65 times the recommended choline amount for adult cats. No glycols were detected. This case documents suspected choline toxicosis in cats after consuming a commercial canned cat food with a higher-than-formulated amount of choline chloride, and it suggests that choline toxicosis may cause a positive result on some EG whole blood tests. Choline toxicosis could be a possible differential diagnosis when a cat has a positive EG test and no known exposure to antifreeze.
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Affiliation(s)
- Sarah K Peloquin
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Veterinary Laboratory Investigation and Response Network, Laurel, MD.
| | - David S Rotstein
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - Jennifer L Jones
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Veterinary Laboratory Investigation and Response Network, Laurel, MD
| | - Jake Guag
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Veterinary Laboratory Investigation and Response Network, Laurel, MD
| | - Lauren Carey
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - Lee Anne Palmer
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - Krisztina Wolf
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - William Burkholder
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - April Hodges
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - Lloyd Payne
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Surveillance and Compliance, Rockville, MD
| | - Renate Reimschuessel
- United States Food and Drug Administration, Center for Veterinary Medicine, Office of Research, Veterinary Laboratory Investigation and Response Network, Laurel, MD
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Grigorasi GR, Nistor I, Corlade-Andrei M, Voroneanu L, Siriopol D, Apetrei M, Cimpoesu DC, Covic A. Outcomes of death and prolonged renal insufficiency in ethylene glycol poisoned patients. Int Urol Nephrol 2021; 54:149-155. [PMID: 33738645 DOI: 10.1007/s11255-021-02837-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the severity of ethylene glycol intoxication, there is a paucity of studies that analyze prognostic factors. This study aims to determine prognostic factors with impact on core outcomes like death and prolonged kidney injury (KI) in ethylene glycol poisoned patients. METHODS We retrospectively assessed prevalence, clinical and biochemical features in one large data set from two regional hospitals from the North-East region of Romania, between January 2012 and October 2017. Secondly, we compared prognostic factors of cases treated with dialysis plus antidote (N = 28 patients) with cases who received antidote only and supportive therapy (N = 28 patients). RESULTS Of the 56 cases included, 16 deaths (28.57%) were recorded. The symptomatology at admission was more severe among patients requiring hemodialysis: a lower mean value for initial pH, lower initial alkaline reserve (AR) and higher mean values for initial serum creatinine (Cr1). The data analysis (survivors/deceased) showed a correlation between pH, Glasgow Coma Score (GCS), and increased mortality. In addition, we found a correlation between initial mean values for pH, AR (mmol/L), Cr1 (mg/dL), and peak Cr24 (mg/dL) with outcomes of RI or death. CONCLUSIONS Compared with survivors, patients who died or had prolonged kidney injury were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Hemodialysis and antidote should be started early and continued until acidosis is corrected.
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Affiliation(s)
- Gabriela Raluca Grigorasi
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
- Emergency Department, Clinical Emergency County Hospital "St. Spiridon", Iasi, Romania.
| | - Ionut Nistor
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Department of Nephrology, Dr CI Parhon" Hospital, Iasi, Romania
| | - Mihaela Corlade-Andrei
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Emergency Department, Clinical Emergency County Hospital "St. Spiridon", Iasi, Romania
| | - Luminita Voroneanu
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Department of Nephrology, Dr CI Parhon" Hospital, Iasi, Romania
| | - Dimitrie Siriopol
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Department of Nephrology, Dr CI Parhon" Hospital, Iasi, Romania
| | - Mugurel Apetrei
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Department of Nephrology, Dr CI Parhon" Hospital, Iasi, Romania
| | - Diana Carmen Cimpoesu
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
- Emergency Department, Clinical Emergency County Hospital "St. Spiridon", Iasi, Romania.
| | - Adrian Covic
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Department of Nephrology, Dr CI Parhon" Hospital, Iasi, Romania
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15
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Poirier-Blanchette L, Simard C, Schwartz BC. Spurious point-of-care lactate elevation in ethylene glycol intoxication: rediscovering a clinical pearl. BMJ Case Rep 2021; 14:14/2/e239936. [PMID: 33568412 PMCID: PMC7878139 DOI: 10.1136/bcr-2020-239936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 76-year-old man was found unresponsive and brought to the emergency department. Initial workup showed profound lactic acidosis on a point-of-care arterial blood gas, without clinical signs of hypoperfusion. Investigations for types A and B lactic acidosis revealed no unifying diagnosis to explain both his altered mental status and profound lactic acidosis. A toxicology workup revealed an increased osmolar gap and an elevated ethylene glycol level. The lactic acidosis and his mental status completely normalised within 8 hours of renal replacement therapy initiation and fomepizole administration. Ethylene glycol metabolites have similar molecular structure with L-lactate. Some blood gas analysers are unable to differentiate them, resulting in an artefactual lactate elevation. Our case highlights the importance of recognising a falsely elevated lactate, which should raise clinical suspicion of ethylene glycol poisoning, as the treatment is time-sensitive to prevent complications and mortality.
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Affiliation(s)
| | - Camille Simard
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Blair Carl Schwartz
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada,Division of General Internal Medicine, Jewish General Hospital, Montreal, Quebec, Canada
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16
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Abstract
Many medications and toxins may induce central nervous system (CNS) depression. Even when the intention is to induce CNS depression, other nervous system adverse effects may occur, such as with anesthetics. Pain medications produce characteristic CNS toxicities. Sedative hypnotics may induce altered mentation among systemic toxicities. Stimulants may mimic coma when discontinued abruptly. Acute and chronic carbon monoxide poisoning can lead to altered mental status and prolonged cognitive difficulties. Some medications and environmental toxins can mimic brain death. High clinical suspicion and early recognition of these effects is vital to treatment, most of which is supportive.
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Affiliation(s)
- Monica Krause
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sara Hocker
- Division of Neurocritical Care and Hospital Neurology, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
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17
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Chen SJ, Chiu KY, Chen HY, Lin WY, Chen YH, Chen WC. Animal Models for Studying Stone Disease. Diagnostics (Basel) 2020; 10:diagnostics10070490. [PMID: 32708380 PMCID: PMC7400259 DOI: 10.3390/diagnostics10070490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
Animals have stone disease too. There are several animal models for the research of human stone disease. Rodents are the most frequently used for stone research, although they are not prone to forming crystals in the kidneys. Ethylene glycol (EG), sodium oxalate and l-hydroxyproline are common lithogenic agents. Dogs and pigs were also reported as a study animal for stone disease. However, the breeding costs and body size are too high. The most-used genetic study animal for stone disease was the mouse, but it was high-cost. Calcium oxalate (CaOx) crystals can also be light microscopically observed in the Malphigian tubules of Drosophila melanogaster, induced by adding EG to the food. Genetic studies of flies can be done by cross-breeding, and this has a lower cost than using mice. The fly model also has several advantages, including minimal breeding equipment, the fact that it is easier to reach larger numbers in a short time with flies, that crystals can be observed under microscopy, and that they allow genetic study. We suggest the fly will be an ideal animal model for stone research in the future.
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Affiliation(s)
- Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407204, Taiwan; (S.-J.C.); (K.-Y.C.)
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407204, Taiwan; (S.-J.C.); (K.-Y.C.)
| | - Huey-Yi Chen
- Departments of Obstetrics and Gynecology, Medical Research, and Urology, China Medical University Hospital, Taichung 404332, Taiwan;
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan;
| | - Wei-Yong Lin
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan;
| | - Yung-Hsiang Chen
- Departments of Obstetrics and Gynecology, Medical Research, and Urology, China Medical University Hospital, Taichung 404332, Taiwan;
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan;
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
- Correspondence: (Y.-H.C.); (W.-C.C.)
| | - Wen-Chi Chen
- Departments of Obstetrics and Gynecology, Medical Research, and Urology, China Medical University Hospital, Taichung 404332, Taiwan;
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan;
- Correspondence: (Y.-H.C.); (W.-C.C.)
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18
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Mishra V, Forryan J. When the Cause Is Not Crystal Clear. Reply. N Engl J Med 2020; 382:e59. [PMID: 32402183 DOI: 10.1056/nejmc2001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Vinita Mishra
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - James Forryan
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
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19
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Greene HR, Krasowski MD. Data on the relationship between acetone, ethylene glycol, isopropanol, methanol, and propylene glycol serum/plasma concentrations and osmolal gaps in patients at an academic medical center. Data Brief 2020; 29:105189. [PMID: 32055668 PMCID: PMC7005488 DOI: 10.1016/j.dib.2020.105189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/04/2022] Open
Abstract
Ingestion of toxic alcohols other than ethanol (ethylene glycol, methanol, isopropanol, and propylene glycol) can cause life-threatening complications including altered level of consciousness, respiratory depression, and organ damage from metabolites. Many hospitals lack the ability to specifically analyze these compounds using gas chromatography, gas chromatography/mass spectrometry, or by enzymatic assays for ethylene glycol. Consequently, the presence of these compounds in blood is often ascertained indirectly by laboratory testing for acid-base status, osmolal gap, and anion gap. In the related research article, we analyzed 260 samples originating from 158 unique patients that had osmolal gap and specific testing for toxic alcohols performed on serum/plasma at an academic medical center central clinical laboratory. The data in this article provide the patient demographic, osmolal gap (and associated laboratory tests needed for this calculation), ethanol concentration by enzymatic assay, specific testing for toxic alcohols (ethylene glycol, isopropanol, methanol, propylene glycol) and acetone, anion gap, clinical history, antidotal treatment, and estimated timing of ingestion. The analyzed data is provided in the supplementary tables included in this article. Bias plots of osmolal gap estimations are included in a figure. The dataset reported is related to the research article entitled "Correlation of Osmolal Gap with Measured Concentrations of Acetone, Ethylene Glycol, Isopropanol, Methanol, and Propylene Glycol in Patients at an Academic Medical Center" [1].
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Affiliation(s)
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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20
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Krasowski MD. Educational Case: Ethylene Glycol Poisoning. Acad Pathol 2020; 7:2374289519900330. [PMID: 31984224 PMCID: PMC6961139 DOI: 10.1177/2374289519900330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/04/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology
Competencies for Medical Education (PCME), a set of national standards for teaching
pathology. These are divided into three basic competencies: Disease Mechanisms and
Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology.
For additional information, and a full list of learning objectives for all three
competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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21
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Greene HR, Krasowski MD. Correlation of osmolal gap with measured concentrations of acetone, ethylene glycol, isopropanol, methanol, and propylene glycol in patients at an academic medical center. Toxicol Rep 2019; 7:81-88. [PMID: 31908969 PMCID: PMC6939068 DOI: 10.1016/j.toxrep.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/13/2022] Open
Abstract
The ingestion of toxic alcohols including methanol, ethylene glycol, and isopropanol remains a significant public health problem. These compounds can cause central nervous system depression and, for methanol and ethylene glycol, organ damage from toxic metabolites. The presence of these compounds in serum/plasma can often be determined and monitored by measuring the osmolal gap (OG). However, other compounds originating from endogenous or exogenous sources, such as propylene glycol and acetone, can also increase the OG. Conversion factors can be used to estimate specific concentrations of acetone and toxic alcohols from OG. In this retrospective study, data were analyzed for 260 samples originating from 158 unique patients that had determination of both OG and concentrations for toxic alcohols at an academic medical center central laboratory. Specific analysis included gas chromatography (acetone, isopropanol, methanol, ethylene glycol, propylene glycol) and/or enzymatic assay (ethylene glycol). Many samples also contained ethanol. The data was grouped by type of ingestion. The present study analyzed the relationship between the OG calculated from measured plasma/serum osmolality and the OG estimated by applying conversion factors to measured concentrations of the different compounds. The correlations tend to be linear and vary by compound, with methanol and ethylene glycol having the highest R2 values of 0.93 and 0.95, respectively, consistent with other published studies. Higher variability was seen for the data for isopropanol and acetone. For each of the data subsets, the estimated toxic alcohol concentration calculated using conversion factors from OG tends to overestimate the actual concentration of the compound. Overall, the present study demonstrates the generally linear relationship between OG determined by osmolality and the OG estimated using measured concentrations of acetone and toxic alcohols.
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Affiliation(s)
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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22
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Greenwald KE, Peak DA, Wittels K, Wilcox SR. Acute Intoxication. J Emerg Med 2019; 57:387-389. [PMID: 31296353 DOI: 10.1016/j.jemermed.2019.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Kelsy E Greenwald
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - David A Peak
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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23
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Pedersen DS, Bélanger P, Frykman M, Andreasen K, Goudreault D, Pedersen H, Hindersson P, Breindahl T. Ethylene glycol: Evidence of glucuronidation in vivoshown by analysis of clinical toxicology samples. Drug Test Anal 2019; 11:1094-1108. [PMID: 30845374 PMCID: PMC6767423 DOI: 10.1002/dta.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/06/2022]
Abstract
In the search for improved laboratory methods for the diagnosis of ethylene glycol poisoning, the in vivo formation of a glucuronide metabolite of ethylene glycol was hypothesized. Chemically pure standards of the β‐O‐glucuronide of ethylene glycol (EG‐GLUC) and a deuterated analog (d4‐EG‐GLUC) were synthesized. A high‐performance liquid chromatography and tandem mass spectrometry method for determination of EG‐GLUC in serum after ultrafiltration was validated. Inter‐assay precision (%RSD) was 3.9% to 15.1% and inter‐assay %bias was −2.8% to 12.2%. The measuring range was 2–100 μmol/L (0.48–24 mg/L). Specificity testing showed no endogenous amounts in routine clinical samples (n = 40). The method was used to analyze authentic, clinical serum samples (n = 31) from patients intoxicated with ethylene glycol. EG‐GLUC was quantified in 15 of these samples, with a mean concentration of 6.5 μmol/L (1.6 mg/L), ranging from 2.3 to 15.6 μmol/L (0.55 to 3.7 mg/L). In five samples, EG‐GLUC was detected below the limit of quantification (2 μmol/L) and it was below the limit of detection in 11 samples (1 μmol/L). Compared to the millimolar concentrations of ethylene glycol present in blood after intoxications and potentially available for conjugation, the concentrations of EG‐GLUC found in clinical serum samples are very low, but comparable to concentrations of ethyl glucuronide after medium dose ethanol intake. In theory, EG‐GLUC has a potential value as a biomarker for ethylene glycol intake, but the pharmacokinetic properties, in vivo/vitro stability and the biosynthetic pathways of EG‐GLUC must be further studied in a larger number of patients and other biological matrices.
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Affiliation(s)
- Daniel Sejer Pedersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical SciencesUniversity of Copenhagen Copenhagen Denmark
| | - Patrick Bélanger
- Centre de Toxicologie du Québec (CTQ)Institut National de Santé Publique du Québec (INSPQ), Québec Québec Canada
| | - Mikael Frykman
- Department of Drug Design and Pharmacology, Faculty of Health and Medical SciencesUniversity of Copenhagen Copenhagen Denmark
| | - Kirsten Andreasen
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
| | - Danielle Goudreault
- Laboratory of Specialized Biochemistry, Department of Clinical BiochemistryOptilab Montréal CHUM, building CHU Ste‐Justine, Montréal Quebec Canada
| | | | - Peter Hindersson
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
| | - Torben Breindahl
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
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24
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Sheta HM, Al-Najami I, Christensen HD, Madsen JS. Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:689-693. [PMID: 29899323 PMCID: PMC6032399 DOI: 10.12659/ajcr.908569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 57 Final Diagnosis: Ethylene glycol poisoning Symptoms: Unconsciousness and high anion gap Medication: Bicarbonate • electrolyte correction • intravenous ethyl alcohol infusion • hemodialysis Clinical Procedure: icroscopy of calcium oxalate monohydrate crystals Specialty: Nephrology • Intensive Care Unit • Biochemistry and Immunology
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Affiliation(s)
- Hussam Mahmoud Sheta
- Department of Anaesthesia and Intensive Care, Lillebaelt Hospital, Kolding, Denmark
| | - Issam Al-Najami
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
| | | | - Jonna Skov Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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25
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Prinz J, Böll B, von Bergwelt-Baildon M, Burst V, Becker JU, Carvalho-Fiel D, Shimabukuro-Vornhagen A, Kochanek M. Intoxikation nach Frostschutzmittelaufnahme. Med Klin Intensivmed Notfmed 2018; 114:159-163. [DOI: 10.1007/s00063-018-0439-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
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Affiliation(s)
- Jeffrey A Kraut
- From Medical and Research Services and Division of Nephrology, Veterans Health Administration Greater Los Angeles (VHAGLA) Healthcare System, and Membrane Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles - both in Los Angeles (J.A.K.); and the Division of Emergency Medicine, Washington University School of Medicine, St. Louis (M.E.M.)
| | - Michael E Mullins
- From Medical and Research Services and Division of Nephrology, Veterans Health Administration Greater Los Angeles (VHAGLA) Healthcare System, and Membrane Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles - both in Los Angeles (J.A.K.); and the Division of Emergency Medicine, Washington University School of Medicine, St. Louis (M.E.M.)
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27
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Ringler S, Gmuer R, Faber K, Bleisch J, Müggler SA. [CME: Ethylene Glycol Intoxication]. PRAXIS 2018; 107:1097-1106. [PMID: 30278847 DOI: 10.1024/1661-8157/a003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.
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Affiliation(s)
| | - Roman Gmuer
- 1 Klinik für Innere Medizin, Spital Zollikerberg
| | - Katrin Faber
- 2 Tox Info Suisse, Assoziiertes Institut der Universität Zürich
| | - Jörg Bleisch
- 3 Nephrologie- und Dialysezentrum, Spital Zollikerberg
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28
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Sommerfeld-Klatta K, Przystanowicz J, Kowalówka-Zawieja J, Zielińska-Psuja B. Effect of repeated administration of 4-methylpyrazole on renal function and lipid peroxidation products in rat kidney after ethylene glycol poisoning. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2017; 56:290-296. [PMID: 29091817 DOI: 10.1016/j.etap.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
Toxic effects of ethylene glycol (EG) and its metabolites are mainly related to metabolic acidosis and kidney damage. EG biotransformation involving CYP2E1 affects the oxidant-antioxidant balance. The study assessed the effect of repeated administration of 4-methylpyrazole (4MP, 15mg/kg b.w. after 2h, followed by 10mg/kg b.w. every 12h) on renal function (creatinine, urea and urinary protein levels) as well as products of kidney's lipid peroxidation (MDA and TBARS levels) in rats poisoned with EG (5745mg/kg b.w.). Serum EG and glycolic acid (GA) concentrations were measured throughout the experiment. Repeated administration of 4MP reduced the rate of EG elimination, extended the period of EG persistence in serum and significantly limited formation of GA. The study showed the temporary intensification of kidney oxidative processes that correlated with changes in kidney function. It was found that the use of 4MP in EG poisoning inhibited its biotransformation to toxic metabolites, but simultaneously intensified oxidative damages in kidneys.
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29
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Rooney SL, Ehlers A, Morris C, Drees D, Davis SR, Kulhavy J, Krasowski MD. Use of a Rapid Ethylene Glycol Assay: a 4-Year Retrospective Study at an Academic Medical Center. J Med Toxicol 2017; 12:172-9. [PMID: 26553280 DOI: 10.1007/s13181-015-0516-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ethylene glycol (EG) is a common cause of toxic ingestions. Gas chromatography (GC)-based laboratory assays are the gold standard for diagnosing EG intoxication. However, GC requires specialized instrumentation and technical expertise that limits feasibility for many clinical laboratories. The objective of this retrospective study was to determine the utility of incorporating a rapid EG assay for management of cases with suspected EG poisoning. The University of Iowa Hospitals and Clinics core clinical laboratory adapted a veterinary EG assay (Catachem, Inc.) for the Roche Diagnostics cobas 8000 c502 analyzer and incorporated this assay in an osmolal gap-based algorithm for potential toxic alcohol/glycol ingestions. The main limitation is that high concentrations of propylene glycol (PG), while readily identifiable by reaction rate kinetics, can interfere with EG measurement. The clinical laboratory had the ability to perform GC for EG and PG, if needed. A total of 222 rapid EG and 24 EG/PG GC analyses were documented in 106 patient encounters. Of ten confirmed EG ingestions, eight cases were managed entirely with the rapid EG assay. PG interference was evident in 25 samples, leading to 8 GC analyses to rule out the presence of EG. Chart review of cases with negative rapid EG assay results showed no evidence of false negatives. The results of this study highlight the use of incorporating a rapid EG assay for the diagnosis and management of suspected EG toxicity by decreasing the reliance on GC. Future improvements would involve rapid EG assays that completely avoid interference by PG.
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Affiliation(s)
- Sydney L Rooney
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Alexandra Ehlers
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Cory Morris
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Denny Drees
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Scott R Davis
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Jeff Kulhavy
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
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30
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Hamilton P, Hamilton J. Concerns Over Accuracy of Record-High Ethylene Glycol Level. J Emerg Med 2017; 52:e69. [PMID: 28215735 DOI: 10.1016/j.jemermed.2015.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/17/2015] [Indexed: 06/06/2023]
Affiliation(s)
- Paul Hamilton
- Belfast Health and Social Care Trust, Belfast, United Kingdom
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31
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Sankaralingam A, Thomas A, James DR, Wierzbicki AS. Assessment of a semi-quantitative screening method for diagnosis of ethylene glycol poisoning. Ann Clin Biochem 2016; 54:501-503. [PMID: 27687084 DOI: 10.1177/0004563216672892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ethylene glycol poisoning remains a rare but important presentation to acute toxicology units. Guidelines recommended that ethylene glycol should be available as an 'urgent' test within 4 h, but these are difficult to deliver in practice. This study assessed a semi-quantitative enzymatic spectrophotometric assay for ethylene glycol compatible with automated platforms. Methods The ethylene glycol method was assessed in 21 samples from patients with an increased anion gap and metabolic acidosis not due to ethylene glycol ingestion, and seven samples known to contain ethylene glycol. All samples were analysed in random order in a blinded manner to their origin on a laboratory spectrophotometer. Results In this study, seven samples were known to contain ethylene glycol at concentrations >100 mg/L. The method correctly identified all seven samples as containing ethylene glycol. No false-positives were observed. Thirteen samples gave clear negative results. Ethylene glycol was present at <20 mg/L in one sample, but this sample remained within the limits of the negative control. Passing-Bablock correlation of estimates of ethylene glycol concentration against results obtained when the samples had been analysed using the quantitative method on an automated analyser showed a good correlation (R = 0.84) but with an apparent under-recovery. Conclusions A semi-quantitative assay for ethylene glycol was able to discriminate well between samples containing ethylene glycol and those with other causes of acidosis. It is a practical small-scale assay for rapid identification of cases of ethylene glycol poisoning.
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Affiliation(s)
| | - Annette Thomas
- 2 Welsh External Quality Assessment (WEQAS), Cardiff, UK
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Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen. J Med Toxicol 2016; 11:368-76. [PMID: 26153488 DOI: 10.1007/s13181-015-0492-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ford LT, Berg JD. Five-year review of a UK 24 hour testing service for plasma ethylene glycol and diethylene glycol. Ann Clin Biochem 2015; 53:459-65. [DOI: 10.1177/0004563215603731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/16/2022]
Abstract
Background We present a 5-year review of our UK service for plasma ethylene glycol and diethylene glycol determination in cases of acute poisoning. Methods Ethylene glycol and diethylene glycol have been measured on all samples received for screening for toxicity by gas chromatography-flame ionization detection over a five-year period. A detailed audit of the results has been undertaken. Results In this period, we received 811 requests, 56% were for first-time screening and 44% repeat analysis where a positive sample has already been received. Of the first-time screen samples, 33.5% screened positive for glycol poisoning. The mean positive ethylene glycol concentration was 1204 mg/L (range 31 to 8666 mg/L). Diethylene glycol was present in 14% of ethylene glycol positive samples but never found alone. Conclusions The data presented here suggest it is not essential to measure diethylene glycol since its inclusion is rarely likely to change patient management.
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Affiliation(s)
- Loretta T Ford
- Department Clinical Biochemistry, City Hospital, Birmingham, UK
| | - Jonathan D Berg
- Department Clinical Biochemistry, City Hospital, Birmingham, UK
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Abstract
CONTEXT Methanol, ethylene glycol, diethylene glycol, and propylene glycol intoxications are associated with cellular dysfunction and an increased risk of death. Adverse effects can develop quickly; thus, there is a need for methods for rapidly detecting their presence. OBJECTIVE To examine the value and limitations of present methods to diagnose patients with possible toxic alcohol exposure. METHODS I searched MEDLINE for articles published between 1969 and 2014 using the terms: toxic alcohols, serum osmolality, serum osmol gap, serum anion gap, metabolic acidosis, methanol, ethylene glycol, diethylene glycol, propylene glycol, and fomepizole. Each article was reviewed for additional references. RESULTS The diagnosis of toxic alcohol exposure is often made on the basis of this history and physical findings along with an increase in the serum osmol and anion gaps. However, an increase in the osmol and/or anion gaps is not always present. Definitive detection in blood requires gas or liquid chromatography, laborious and expensive procedures which are not always available. Newer methods including a qualitative colorimetric test for detection of all alcohols or enzymatic tests for a specific alcohol might allow for more rapid diagnosis. CONCLUSIONS Exposure to toxic alcohols is associated with cellular dysfunction and increased risk of death. Treatment, if initiated early, can markedly improve outcome, but present methods of diagnosis including changes in serum osmol and anion gap, and use of gas or liquid chromatography have important limitations. Development of more rapid and effective tests for detection of these intoxications is essential for optimal care of patients.
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Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services Veterans Administration Greater Los Angeles Healthcare System, UCLA Membrane Biology Laboratory, and Division of Nephrology, Veterans Administration Greater Los Angeles Healthcare System, and David Geffen School of Medicine , Los Angeles , California
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Cooper CM, Baron JM. Case records of the Massachusetts General Hospital. Case 4-2015. A 49-year-old man with obtundation followed by agitation and acidosis. N Engl J Med 2015; 372:465-73. [PMID: 25629745 DOI: 10.1056/nejmcpc1410940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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