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January 1, 2021

ethylene glycol poisoning urine crystals

Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? Free PDF. NIH (Anti-freeze) Acidic urine. Skip to main page content National Institutes of Health. Toxicity and death may occur after drinking even a small amount. Ethylene glycol is a small molecule (62 dalton) which undergoes rapid absorption from the gastrointestinal tract, distributes to the liver where it is rapidly metabolized by the hepatic alcohol dehydrogenase pathway to toxic metabolites (glycoaldehyde, glycolic acid, glyoxlic acid, oxalic acid, and formic acid), and is excreted in the urine. The presence of calcium oxalate or hippurate crystals in the urine, together with an elevated anion gap or osmolal gap, strongly suggests ethylene glycol poisoning (Albertson 1999). The cytotoxicity of oxalate, metabolite of ethylene glycol, is due to calcium oxalate monohydrate formation. 3; Table 1). They can be observed in cases of ethylene glycol toxicity. Conclusions: Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 3, pp. A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. Oxalate crystals in the urine However these criteria may be too conservative; if there is clinical concern or if laboratory testing will take an extended amount of time to return it is advisable to initiate therapy earlier. Also, we will not be discussing propylene glycol due to the rarity of its consumption. All animals are susceptible to ethylene glycol (EG) toxicity, but it is most common in dogs and cats. Am J Med Sci. Long term outcomes may include kidney failure and brain damage. Oval, spindle or dumb-bell forms are infrequently seen in urine from healthy dogs and cats but can be seen in hypercalciuric conditions and ethylene glycol toxicity.Picket fence form (arrow) are commonly observed in ethylene glycol toxicity in dogs and cats, but can also be seen in animals with hypercalciuria due to other causes (e.g. Acute ingestions present with altered sensorium and an osmolal gap. Ethylene glycol poisoning: an unusual cause of altered mental status and the lessons learned from management of the disease in the acute setting. Early symptoms include intoxication, vomiting and abdominal pain. Calcium Oxalate Monohydrate Crystals: A Clue to Ethylene Glycol Poisoning. Calcium oxalate monohydrate crystals in ethylene glycol poisoning. Calcium oxalate crystals may not be present until the later stages of intoxications. Ammonium biurate Stage 1 (0.5 to 12 hours) consists of neurological and gastrointestinal symptoms; people may appear to be intoxicated, exhibiting symptoms such as Introduction: Premium PDF Package. Pomara C, Fiore C, D'Errico S, Riezzo I, Fineschi V. Clin Toxicol (Phila). Urinary crystals … This can be highly suggestive of ethylene glycol poisoning under the right circumstances. 2016;2016:9157393. ... Monohydrate crystals are seen in the ethylene glycol (antifreeze) poisoning. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. Calcium oxalate is a combination of calcium ions and the conjugate base of oxalic acid, the oxalate anion. Urinary calcium oxalate monohydrate crystals in ethylene glycol poisoning. eCollection 2018 Nov. Sheta HM, Al-Najami I, Christensen HD, Madsen JS. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. Most ethylene glycol poisonings occur due to the ingestion of antifreeze. The left image above is from the urine of a dog with many of these crystals. They generally only form in an acidic urine.  |  A relevant clue to isopropanol ingestion is positivity for acetone in the urine or blood without attendant hyperglycemia. 2018 Mar-Apr;8(2):170-178. Images in Clinical Medicine from The New England Journal of Medicine — Urinary Calcium Oxalate Crystals in Ethylene Glycol Intoxication PDF. 2008 Apr;46(4):322-4. doi: 10.1080/15563650701419011. Coma with grave metabolic acidosis, increased anion and osmolal gap, oxalate crystals in urine sediment and increased ultrasound density of the renal parenchyma are essential clues to the diagnosis of ethylene glycol poisoning. Emamiyan MZ, Vaezi G, Tehranipour M, Shahrohkabadi K, Shiravi A. Avicenna J Phytomed. Calcium oxalate monohydrate crystals: a clue to ethylene glycol poisoning. Calcium Oxalate Monohydrate Crystals: A Clue to Ethylene Glycol Poisoning. Triple phosphate crystals or struvite stones: Form in alkaline urine and composed of magnesium, ammonium, and phosphate. 2009 Nov;47(9):859-69. doi: 10.3109/15563650903344793. Discussion: The presence of crystals in the urine is called Crystalluria. Fomepizole is a new agent with a specific indication by the U.S. Food and Drug Administration for the treatment of ethylene glycol poisoning.4, 6, 7, … Ann Clin Biochem. Forensic Sci Int. Lumlertgul N, Siribamrungwong M, Jaber BL, Susantitaphong P. Kidney Int Rep. 2018 Jul 29;3(6):1363-1372. doi: 10.1016/j.ekir.2018.07.020. [Cigar-like oxalate crystals in ethylene glycol poisoning]. Common w/ kidney stones, also toxic effects of ethylene glycol poisoning. When discussing toxic alcohols, it is important to define what constitutes a “toxic” alcohol. Please enable it to take advantage of the complete set of features! Chemical properties. Epub 2016 Sep 2. 2014 Sep;10(3):401-12. doi: 10.1007/s12024-014-9536-9. Ethylene glycol is found in many household products and is a common toxic ingestion. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. They can be observed in cases of ethylene glycol toxicity. A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. Two days after admission, the patient was awake and in clinical recovery. Glycolic acid causes severe acidosis and oxalate precipitates as calcium oxalate in the kidneys and other tissues. Luqman A, Stanifer J, Asif Siddiqui OM, Naseer A, Wall BM. Monohydrate crystals are the predominant form of oxalate crystal seen with ethylene glycol poisoning. Any alcohol when consumed in enough of a quantity can be toxic; however, we will not discuss ethanol as it is not one of the classic “toxic alcohols.” These typically include methanol, ethylene glycol, propylene glycol, and isopropanol (isopropyl alcohol). 42, No. Calcium oxalate crystals in acute ethylene glycol poisoning: a confocal laser scanning microscope study in a fatal case. Massive calcium oxalate … The classic laboratory profile of ethylene glycol ingestion is an early osmolar gap (the ethylene glycol serves as an unmeasured osmole) that disappears as an anion gap metabolic acidosis develops (as the ethylene glycol is converted into its acidic derivatives). Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. Some look almost football-shaped; other look more like crystal aggregates. Singh R, Arain E, Buth A, et al. This site needs JavaScript to work properly. Envelope-like dihydrate calcium oxalate crystals are usually found in the sediment of these patients. Microscopic demonstration of calcium oxalate…. Coma with grave metabolic acidosis, increased anion and osmolal gap, oxalate crystals in urine sediment and increased ultrasound density of the renal parenchyma are essential clues to the diagnosis of ethylene glycol poisoning. Ethylene glycol, the predominant constituent of automotive products such as antifreeze and deicers, is an important but uncommon toxicological problem in current medical practice (1)(2). See this image and copyright information in PMC. HHS 2011 Apr;341(4):338. doi: 10.1097/MAJ.0b013e3181e15dbd. PDF.  |   |  Monohydrate crystals are the predominant form of oxalate crystal seen with ethylene glycol poisoning. PDF. NIH Ethylene glycol is the E in the MUDPILES mnemonic, meaning that it causes an elevated anion gap metabolic acidosis. When urine left at room temperature or refrigerated then urine becomes cloudy because of the precipitation of crystals or amorphous material. 2017;13:153–57. ... Monohydrate crystals are seen in the ethylene glycol (antifreeze) poisoning. Preventive effects of the aqueous extract of. 2008 Mar;122(2):173-7. doi: 10.1007/s00414-007-0208-0. Download Free PDF. Ann Emerg Med . Secondary Oxalate Nephropathy: A Systematic Review. According to the annual report of the American Association of Poison Control Centers, ethylene glycol … The values of glycolic and oxalic acid from samples taken at admission were very high but significantly decreased during therapy (Fig. Microscopic demonstration of calcium oxalate monohydrate crystals in a urine sample. [1] Early symptoms include intoxication, vomiting and abdominal pain. 1994 Feb 10;114(4):435-6. Quick diagnosis and treatment are essential to prevent renal failure and life-threating complications. Assessment of a semi-quantitative screening method for diagnosis of ethylene glycol poisoning. Calcium oxalate crystals in acute ethylene glycol poisoning: A confocal laser scanning microscope study in a fatal case. -, Sankaralingam A, Thomas A, James DR, Wierzbicki AS. Symptoms of ethylene glycol poisoning usually follow a three-step progression, although poisoned individuals will not always develop each stage. Triple phosphate crystals or struvite stones: Form in alkaline urine and composed of magnesium, ammonium, and phosphate. It is this acid that combines with serum calcium to form the classic calcium oxalate crystals found in the urine of patients who have consumed ethylene glycol. Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy. Calcium oxalate monohydrate, a metabolite of ethylene glycol, is toxic for rat renal mitochondrial function. -, Pomara C, Fiore C, D’Errico S, et al. -, Hodgman M, Marraffa JM, Wojcik S, Grant W. Serum calcium concentration in ethylene glycol poisoning. Direct toxicity, cortical edema, and inhibition of mitochondrial activity, as evidenced by decreased succinate dehydrogenase activity, are possible mechanisms of crystal damage. Toxicol Sci.  |   |  Download PDF. 231-234. Case Rep Crit Care. Clipboard, Search History, and several other advanced features are temporarily unavailable. BACKGROUND Ethylene glycol poisoning remains an important presentation to Emergency Departments. Ethylene glycol exposure is characterized by an osmolal gap and a metabolic acidosis with an elevated anion gap. Propylene glycol toxicity is seen mainly in an inpatient setting with IV infusions that conta… Accidents involving ethylene glycol ingestion often occur with children. Epub 2004 Dec 15. Calcium oxalate crystals in the urine are the most common constituent of human kidney stones, and calcium oxalate crystal formation is also one of the toxic effects of ethylene glycol poisoning. Most intoxications are associated with ingestion of antifreeze, which is typically 95% EG. Toxicological examinations revealed ethylene glycol; the blood level was 250 mg/L and in urine the concentration was 0.3%. This site needs JavaScript to work properly. Individuals intentionally consume ethylene glycol, usually in the form of antifreeze, as an inexpensive alcohol substitute or as a suicidal agent. Ethylene glycol may be swallowed accidentally, or it may be taken deliberately in a suicide attempt or as a substitute for drinking alcohol (ethanol). A urinalysis may also confirm ethylene glycol poisoning and underlying kidney damage by the presence of dilute urine containing blood, protein, cellular casts (plugs of cells which have taken the shape of dying tubules in the kidneys), and calcium oxalate crystals (which are seen with ethylene glycol poisoning). Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning? Uric acid crystals in the urine are more tricky because they are pleimorphic–they can have many shapes. Tidsskr Nor Laegeforen. Turillazzi E, Karch SB, Neri M, Pomara C, Riezzo I, Fineschi V. Int J Legal Med. Case report: Chemical properties. Acidic urine. Ethylene glycol is a colorless, odorless, sweet-tasting chemical. 1. Epub 2014 Mar 1. [1] Toxicity and death may occur after drinking even a small amount. Some look almost football-shaped; other look more like crystal aggregates. Presence in the urine of either fluorescein or calcium oxalate crystals indicates ethylene glycol exposure, but their absence does not exclude this poisoning. It is poisonous if swallowed. Epub 2005 Jan 21. 2005 Mar 30;208(3):347-55. doi: 10.1016/j.tox.2004.11.029. Blood glucose imbalances Visual appearance of calcium oxalate crystals (circled above) in a urine sample ( source ) Urine analysis under a Wood’s lamp. Calcium oxalate crystals in the urine are the most common constituent of human kidney stones, and calcium oxalate crystal formation is also one of the toxic effects of ethylene glycol poisoning. Nephrotoxicity is the dominant effect of significant ethylene glycol poisoning. Clipboard, Search History, and several other advanced features are temporarily unavailable. Discussion: In cases of ethylene glycol poisoning, calcium oxalate may be excreted not only as dihydrate crystals, but also as monohydrate crystals. Since calcium oxalate monohydrate crystals are transported intracellularly by kidney cells, the renal toxicity of ethylene glycol may result from inhibition of mitochondrial respiratory function in proximal tubular cells by calcium oxalate monohydrate crystals. Clinical Toxicology, 2008. 2009 Nov;47(9):859-69. doi: 10.3109/15563650903344793. Massive calcium oxalate … Calcium oxalate crystals in patient urine samples. NLM lymphoma). Using new technology to answer old questions in forensic investigations. The presence of crystals in the urine is called Crystalluria. 2017;54(4):501–3. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. [1] Long term outcomes may include kidney failure and brain damage. HHS Ethylene glycol poisoning can cause dysrhythmias and heart failure. Keywords: Acidosis; Ethylene Glycol, Hyperglycemia, Poisoning; Renal Insufficiency Ethylene Glycol Poisoning; an Unusual Cause of Hyperglycemia: A Case Report 55 after 24 to 48 hours of EG ingestion. Envelope-shaped crystals of calcium oxalate may be seen in the urine except in case of significant renal failure (8). The dog did not have ethylene glycol poisoning and the crystals are assumed to be secondary to supersaturation of the urine with calcium and oxalates, which precipitated in the acidic urine. [1] Later symptoms may include a decreased level of consciousness, headache, and seizures.  |  USA.gov. National Library of Medicine. Vittorio Fineschi. Challenges in the diagnosis of ethylene glycol poisoning. The authors report the case of a man 49 years of age with near-fatal ethylene glycol poisoning. CONCLUSIONS Demonstration of COM crystals using microscopy of a urine sample adds valuable information supporting the clinical suspicion of ethylene glycol poisoning, and may serve as an easy, quick, and cheap method that can be performed in any emergency setting. An adult male was taken to the local hospital by the team rescue and was apparently unconscious; severe metabolic acidosis and renal failure led to death a few hours after the arrival. The role of histopathology in forensic practice: an overview. Urine fluorescence using a Wood's lamp to detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected ethylene glycol ingestions. Envelope-like dihydrate calcium oxalate crystals are usually found in the sediment of these patients. Please enable it to take advantage of the complete set of features! The severity of ethylene glycol toxicity is related to the metabolic acidosis resulting from the biotransformation of ethylene glycol into toxic metabolites. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. They generally only form in an acidic urine. 2, Fig. PDF. Forensic Sci Med Pathol. Ammonium biruate crystals can be seen in normal urine. -, McQuade DJ, Dargan PI, Wood DM. Calcium oxalate is a combination of calcium ions and the conjugate base of oxalic acid, the oxalate anion. Epub 2007 Oct 9. Ethylene glycol is found in many household products and is a common toxic ingestion. 2017 Aug;21(4):741-742. doi: 10.1007/s10157-016-1332-2. In cases of ethylene glycol poisoning, calcium oxalate may be excreted not only as dihydrate crystals, but also as monohydrate crystals. Uric acid crystals in the urine are more tricky because they are pleimorphic–they can have many shapes. Confocal laser scanning microscopy demonstrated oxalate crystals deposition within the tubular epithelial cells and widespread necrosis of the tubular epithelium in the proximal tubules. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. ANNA J. National Library of Medicine. 1999 Jun;26(3):295-300, 335; quiz 301-2. Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. The patient was treated with continuous intravenous ethyl alcohol infusion and hemodialysis. Confocal laser scanning microscopy. -. Clin Toxicol (Phila). 2014;51:167–78. Clin Toxicol (Phila) 2008;46:322–24. 2005 Dec 20;155(2-3):179-84. doi: 10.1016/j.forsciint.2004.11.012. The classic laboratory profile of ethylene glycol ingestion is an early osmolar gap (the ethylene glycol serves as an unmeasured osmole) that disappears as an anion gap metabolic acidosis develops (as the ethylene glycol is converted into its acidic derivatives). Calcium Phosphate: Can have different morphologies depending on state of hydration. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. CASE REPORT In this case report, we present a patient who was admitted unconscious to the hospital. Toxicology. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. It is most commonly encountered as automotive antifreeze.Diethylene glycol behaves similarly to ethylene glycol in an overdose. Calcium oxalate crystals in acute ethylene glycol poisoning: A confocal laser scanning microscope study in a fatal case. Acute ingestions present with altered sensorium and an osmolal gap. COVID-19 is an emerging, rapidly evolving situation. Skip to main page content National Institutes of Health. When urine left at room temperature or refrigerated then urine becomes cloudy because of the precipitation of crystals or amorphous material. Download PDF Package. The histologic diagnosis of acute renal failure secondary to ethylene glycol poisoning depends on the recognitions of the changes of acute tubular damage in association with calcium oxalate crystals deposition within the tubular epithelial cells and the widespread necrosis of the tubular epithelium in the proximal tubules. Later symptoms may include a decreased level of consciousness, headache, and seizures. J Med Toxicol. 1990 Jun. Ethylene glycol intoxication: pathophysiology, diagnosis, and emergency management. Urine sediments of dogs with experimentally induced ethylene glycol poisoning were examined by light microscopy and X-ray diffraction. Ann Clin Biochem. Clipboard, Search History, and several other advanced features are temporarily unavailable. (1982). NLM Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. USA.gov. Ethylene glycol (C2H6O2 Ethylene glycol is an odorless, colorless, sweet-tasting syrupy substance with a molecular weight of 62.07, freezing point of -13°C and a boiling point of 197.6°C. Clin Toxicol (Phila). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. These 95% commercial antifreeze preparations are diluted ~50% with water when used in vehicle cooling systems. Am J Case Rep. 2018 Jun 14;19:689-693. doi: 10.12659/AJCR.908569. Clipboard, Search History, and several other advanced features are temporarily unavailable. Massive calcium oxalate crystalluria was observed in all poisoned dogs. COVID-19 is an emerging, rapidly evolving situation. 2005 Mar;84(1):195-200. doi: 10.1093/toxsci/kfi062. Toxicological examinations revealed ethylene glycol; the blood level was 250 mg/L and in urine the concentration was 0.3%. International Scientific Literature, Ltd. Clin Exp Nephrol. Calcium concentration in ethylene glycol test in suspected ethylene glycol is found in the ethylene glycol poisoning is caused! Immediately suspected, because the patient had previously been hospitalized with similar symptoms intake... They are pleimorphic–they can have many shapes then urine becomes cloudy because of the of! Renal mitochondrial function: the severity of ethylene glycol poisoning urine is called Crystalluria of man... 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Days after admission, the oxalate anion who was admitted unconscious to the metabolic acidosis with elevated! Alkaline urine and composed of magnesium, ammonium, and Emergency management ] long term outcomes may include a level! Urinary crystals … All animals are susceptible to ethylene glycol is the E the. Admission, the oxalate anion 2-3 ):179-84. doi: 10.1016/j.forsciint.2004.11.012:.! A Wood 's lamp to detect the antifreeze additive sodium fluorescein: Clue.:347-55. doi: 10.1097/MAJ.0b013e3181e15dbd of antifreeze, as an inexpensive alcohol substitute or as a agent... Symptoms of ethylene glycol poisoning is poisoning caused by drinking ethylene glycol a metabolic acidosis small amount very high significantly. Oxalate in the MUDPILES mnemonic, meaning that it causes an elevated anion gap failure... Two days after admission, the oxalate anion 2005 ethylene glycol poisoning urine crystals 30 ; (!

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