Autonomic Dysfunction as a Delayed Sequelae of Acute Ethylene Glycol Ingestion

Abstract

Ethylene glycol poisoning is a common form of poisoning worldwide. The clinical course of ethylene glycol poisoning usually follows a three-stage progression, although these stages may overlap. A fourth stage of delayed neurological dysfunction consisting of cranial neuropathies has been suggested in several case reports. We describe a patient with unique findings of postural hypotension and gastroparesis following ethylene glycol toxicity with the additional uncommon features of albuminocytologic dissociation and increased intracranial pressure with papilledema. In addition, we provide a review of the literature on delayed neurological manifestations in ethylene glycol toxicity and further elucidate a description of a fourth stage of delayed neurological dysfunction following ethylene glycol poisoning.

A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy

“…If appropriate treatment is not administered during this period, multiple organ failures may occur, which can lead to death. Third, the renal stage appears between 24 and 72 h after ingestion, during which calcium oxalate crystals are deposited in the tubules, causing acute renal failure 6 9) . However, there are significant differences between individuals; in some patients, one stage may be predominant, while other stages may not appear at all.…”

Lost Seasonality and Overconsumption of Plants: Risking Oxalate Toxicity

“…Oxalate ions and nano-crystals are increasingly implicated as a cause or aggravator of a wide range of metabolic derangements associated with chronic health issues [64][65][66] . Dramatic increases in calcium-oxalate kidney stones, and functional problems with digestive health 49 , neurotoxicity 59,61,[67][68][69] (sleep, brain function), inflammation 48,[70][71][72][73][74] (chronic pain, autoimmunity, cellular stress, fatigue, arthritis), and connective tissue instability 46,73,75,76 (osteoporosis, vulnerability to injury) are all consistent with increased oxalate toxicity 43,77,78 . Yet, these conditions (in tandem with the epidemic of insulin resistance and obesity) have led people to select foods purported to be healthier, many of which are high in oxalate.…”

Beyond the Usual Suspects: Ethylene Glycol Poisoning Complicated by Rare Neurological Sequelae

“…Phase 2 (12-24 hours): accumulation of organic acids leading to cardiopulmonary syndrome with symptoms like tachycardia, hypertension, tachypnea, and pulmonary edema. Phase 3 (24-72 hours): renal failure due to osmotic damage and calcium oxalate accumulation in the kidneys, with metabolic acidosis persisting throughout [ 3 ].…”

“…Additionally, severe cases may exhibit a fourth phase characterized by neurological sequelae, including delayed cranial neuropathies, cerebral edema, seizures, increased intracranial pressure, stroke-like symptoms, diaphragmatic paralysis, sensory radiculopathies, and autonomic nervous system dysfunction [ 3 ].…”