Clinical Features of Reported Ethylene Glycol Exposures in the United States

BackgroundEthylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.Methods and FindingsUsing the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.ConclusionDeaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.背景 乙二醇（ethylene glycol）毒性极强，是全球范围内中毒事件的重要诱因之一。其毒性可引发中枢神经系统功能障碍、心血管功能受损、阴离子间隙代谢性酸中毒以及急性肾损伤（acute kidney injury）。美国多个州已出台法规，要求在乙二醇溶液中添加苦味剂苯甲地那铵（denatonium benzoate），以降低中毒暴露的严重程度。本研究旨在区分意外暴露与故意暴露之间的差异，并评估苯甲地那铵作为阻食剂的应用价值。方法与结果 本研究依托国家毒物数据系统（National Poison Data System），对2006年1月至2013年12月间报告的乙二醇暴露病例开展回顾性分析。以暴露的故意性为基础进行结局分类，并以此作为效应组比较的依据。本次研究共纳入45097例乙二醇暴露病例，其中154例死亡。年龄偏大、男性且症状更严重（需更高等级医疗照护）的个体，发生严重不良结局或死亡的风险更高。纬度与季节与暴露发生率增加无相关性，但农村地区的暴露事件更为多发。苯甲地那铵的使用似乎对暴露严重程度或暴露数量均无显著影响。结论 乙二醇暴露导致的死亡案例并不常见，但农村地区的严重临床不良事件与暴露事件均更多。添加苯甲地那铵并未降低乙二醇暴露事件的发生。目前仍需探索其他阻食手段。本研究结果提示，应考虑使用毒性更低的替代物质取代乙二醇。