Ethylene Glycol intoxication with and without simultaneous diabetic ketoacidosis: A report of nine cases and review of the literature

Objective: To describe the clinical and biochemical observations made on nine patients with ethylene glycol intoxication (EGI) of whom five presented with simultaneous diabetic ketoacidosis (DKA). Methods: A retrospective chart search for discharge diagnosis including the term ethylene glycol intoxication was conducted at University Hospitals of Cleveland Information Services (Cleveland, OH) from 1986 through 1998. Nine (N=9) patients were identified and subsequently divided into two Groups (A & B). Group A included 5 patients with both DKA and EGI. Group B included 4 patients with EGI without DKA. Clinical manifestations and laboratory tests are summarized for both Groups. Serum specimens for all patients were analyzed for ethylene glycol, propylene glycol, methanol, serum ketones, glucose, pH, electrolytes, liver and kidney function tests, lipase, amylase, cholesterol, triglycerides, C-peptide and glycosylated Hb. Results: Group A patients presented with more severe hyperglycaemia accompanied by increased insulin requirements, glucose toxicity, more severe osmotic diuresis induced severe dehydration, pre-renal azotemia, transient rhabdomyolysis and hypertriglyceridaemia. Their acute renal failure was fully reversible upon discharge. Finally, the length of hospital stay of patients in Group A was significantly longer than that of Group B patients, although mortality rate was reduced. Permanent and irreversible kidney damage requiring haemodialysis was seen in all Group B patients. Conclusions: severe DKA presenting with simultaneous high anion and osmolal gap should prompt suspicion to the hypothetical concomitant EGI, particularly in those patients with a history of alcoholism, depression and past suicidal attempts.