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Ethylene Glycol (ETHG)

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EPIC Test Name

ETHYLENE GLYCOL

EPIC Code

LAB714

Reference Lab

This test is performed by a partner lab as indicated below.

LabReferral
Click Here to visit Strong Hospital

Specimen Requirements

serum
Minimum Volume:4 mL
Collection:Collect specimens using standard laboratory procedures.
Transport:Room Temperature ASAP
Notes:1. Physician determines that ethylene glycol and methanol levels are necessary and calls Poison Control Center (PCC).
2. PCC reviews patinet chart and approves/denies testing. If testing is approved, PCC directes the physician in the details of ordering.
3. Patient sample is drawn in a gold top tube and sent to the laboratory.
4. Lab notified PCC that a specimen has been received and confirms PCC approval for testing.
5. Complete UR Medicine Labs Requisition. Make one copy to leave in Sendout area.
6. Centrifuge tube, but DO NOT OPEN. Send original specimen and requisition in a specimen bag and brown paper bag.
7. Call for a STAT Courier.
8. Results are verbally reported to PCC by UR Medicine Labs.
9. Poison Control Specialists will relay the results to the clinical staff via telephone.
10. UR Medicine Labs will fax report to SUNY laboratory.
11. SUNY reference lab personnel will enter result into the LIS/EPIC.

Methods

Sendout test

Turnaround Time

SpecimenFrequency
serum24/7

Reference Ranges

Sendout test
All RangeUnit
NEGmg/dL

Clinical Indications

Ethylene glycol is a colorless, odorless, sweet tasting compound present in antifreeze products, deicing products, detergents, paints, and cosmetics. It may be ingested accidentally, or for inebriation or suicide attempts. Patients taking ethylene glycol initially may present with a wide variety of neurological symptoms resembling ethanol intoxication. Its metabolites, including glycolic acid and oxalic acid, form following the breakdown of ethylene glycol and are responsible for the compound's toxicity.

The toxic effects can be divided into three stages. The timing for each stage may vary and overlap between stages. The first stage occurs 30 minutes to 12 hours following ingestion and effects may range from mild neurological depression to coma. The second stage occurs 12 to 24 hours following ingestion and is characterized by severe metabolic acidosis, due to acid metabolite accumulation, and cardiopulmonary symptoms. The third stage occurs 24 to 72 hours following ingestion and is characterized by renal failure due to calcium oxalate crystal deposition in the proximal tubules.

Therapy for ethylene glycol toxicity includes administration of ethanol or fomepizole as a competitive ADH inhibitor and dialysis.

Additional Information

Patients with methylmalonic acidemia, a rare inborn error of metabolism, produce propionic acid which may be confused with ethylene glycol poisoning in the gas chromatographic assay.

Specimens collected in serum gel tubes are not acceptable as the compound can be absorbed on the gel leading to falsely decreased concentrations.

An increased osmolar gap can be present early on following ingestion before significant metabolism has occurred. Following metabolism, the osmolar gap resolves and an anion gap metabolic acidosis occurs. Therefore, toxicity may be seen, however, without increases in the osmolar gap. Anion gap increases can occur with very low levels of ethylene glycol due to shorter half-life (t ½ = 3 - 8.6 hours) while the level of acidic metabolites remains elevated.

Interpretative Information

Toxic concentrations in serum/plasma are greater than or equal to 20 mg/dL.

CPT

82693

LOINC

5646-5

References

1. Cheng S, Schindler EI, Scott MG: Disorders of water, electrolytes, and acid-base metabolism. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018: 1343.
2. Iqbal A, Glagola JJ, Nappe TM. Ethylene Glycol Toxicity. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

3. Langman LJ, Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:843-4.

4. Milone MC, Shaw LM: Glycols. In: Kwon TC, Magnani B, Rosano, TG, Shaw LM eds. The Clinical Toxicology Laboratory. 2nd ed. AACC Press; 2013:79-96.
5. Shoemaker JD, Lynch RE, Hoffman JW, Sly WS. Misidentification of propionic acid as ethylene glycol in a patient with methylmalonic acidemia. J Pediatr. 1992;120:417-21. DOI: 10.1016/s0022-3476(05)80909-6.
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