Long-term Renal and Neurologic Outcomes Among Survivors of Diethylene Glycol Poisoning

Conklin, Laura; Sejvar, James J.; Kieszak, Stephanie; Sabogal, Raquel; Sánchez, Carlos; Flanders, Dana; Tulloch, Felicia; Gerardo, Victoria; Rodriguez, Giselle M.; Sosa, Néstor; McGeehin, Michael A.; Schier, Joshua G.

doi:10.1001/jamainternmed.2014.344

Cited by 22 publications

(8 citation statements)

References 14 publications

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“…Although RRT could be withdrawn in this case, one report showed 90.0% of dialysis‐dependent patients from DEG poisoning remained so over time 3. Clinicians should recognize a possible necessity of long‐term RRT for such cases.…”

Section: Tablementioning

confidence: 85%

Delayed sensorimotor neuropathy and renal failure: an additional report in a patient with diethylene glycol poisoning

Kamada

Suzuki

Kushimoto

2017

Acute Medicine & Surgery

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Section: Tablementioning

confidence: 85%

Delayed sensorimotor neuropathy and renal failure: an additional report in a patient with diethylene glycol poisoning

Kamada

Suzuki

Kushimoto

2017

Acute Medicine & Surgery

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“…Long-term follow-up of survivors of DEG positioning for up to 18 months was recently published. 25 It reported a mortality of 15.6% at 18 months and a tendency toward neurological improvement. Renal improvement was also observed in the nondialysis-dependent patients.…”

Section: Discussionmentioning

confidence: 96%

Neurological Manifestation of Recreational Fatal and Near-Fatal Diethylene Glycol Poisonings

Imam¹,

Kamran²,

Karim³

et al. 2014

Medicine

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Diethylene glycol is a common industrial solvent which is responsible for accidental and epidemic poisoning as early as the 1930s. Due to the unavailability and unaffordability of ethanol, people in Qatar among the low income group are consuming household chemicals, some of which contain diethylene glycol, for recreational purposes.The history of ingestion is usually not volunteered and the initial clinical presentation is usually nonspecific, making it difficult to diagnose from the clinical presentation. Moreover, the biochemical profile varies with time, making the diagnosis more difficult. The neurological course and toxicity is less well characterized than its renal counterpart. Moreover, reports in the literature of such recreational poisoning is lacking particularly in the region.Three cases of recreational diethylene glycol poisoning seen in Hamad General Hospital, Doha, Qatar from 2009 to 2012 are detailed here.These illustrate the clinical course with emphasis on the neurological sequelae that include encephalopathy and multiple cranial and peripheral neuropathies with fatal and near-fatal outcomes. Neuroimaging in 2 were initially normal, but follow-up imaging showed brain atrophy. The third patient’s neuroimaging showed diffuse brain edema with evidence of transtentorial herniation. Nerve conduction studies were performed in 2 of the 3 cases and showed evidence of mixed sensorimotor neuropathy. The outcomes were death in 1 and severe neurological morbidity and disability in 2 cases.Diethylene glycol is a dangerous substance when ingested and can result in mortality and severe morbidity, particularly from the renal and neurological manifestations. Whereas the mechanism of damage is less well known, the damage is likely dose related. The typical clinical pattern of evolution of the poisoning in the absence of cost-effective ways to detect it in the serum can help clinicians in making the diagnosis.Neurological manifestations may include encephalopathy and multiple cranial and peripheral neuropathies with subsequent brain atrophy. Public awareness of the danger of such recreational use should be raised.

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“…To the best of our knowledge, however, this is the first report of autonomic neuropathy complicated with DEG intoxication. The reason why there has been no report of autonomic neuropathy in DEG intoxication is partly because few cases can survive from severe delayed neuropathy in DEG intoxication 3, 4. Rapid‐progressing fatal paralysis and brain atrophy, edema, and infarction, which might be irreversible, were also reported 2, 8, 9.…”

Section: Discussionmentioning

confidence: 99%

“…Diethylene glycol intoxication is marked by gastrointestinal symptoms and hepatorenal injury in the acute phase and delayed neurological complications with evidence of peripheral demyelination that causes quadriparesis and ventilator dependence in severe cases 1, 2, 3, 4. However, autonomic neuropathy in DEG poisoning has never been reported.…”

Section: Introductionmentioning

confidence: 99%

Delayed autonomic neuropathy in a patient with diethylene glycol poisoning: a case report

Kamada

Suzuki

Yamamoto

et al. 2017

Acute Medicine & Surgery

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CaseA 72‐year‐old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11–54.OutcomeEven after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head‐up tilt test, and reduction in coefficient of variation of R‐R intervals and cardiac iodine‐123‐metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol.ConclusionThis case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late‐onset neurological complications.

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Long-term Renal and Neurologic Outcomes Among Survivors of Diethylene Glycol Poisoning

Cited by 22 publications

References 14 publications

Delayed sensorimotor neuropathy and renal failure: an additional report in a patient with diethylene glycol poisoning

Delayed sensorimotor neuropathy and renal failure: an additional report in a patient with diethylene glycol poisoning

Neurological Manifestation of Recreational Fatal and Near-Fatal Diethylene Glycol Poisonings

Delayed autonomic neuropathy in a patient with diethylene glycol poisoning: a case report

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