Diethylene glycol is a toxic alcohol associated with a high morbidity and mortality. There is often a delay in diagnosis.
Exposure: industrial production of plastics, brake fluid, alcohol adulterant or solvent for medications
Chemical formula: (HOCH2CH2)2O
Toxic metabolite: 2-hydroxyethoxyacetic acid (HEAA)
Neurologic toxicity:
(1) headache
(2) altered mental status (including coma)
(3) rare cranial neuropathies and/or bulbar palsy
Intra-abdominal complaints:
(1) abdominal pain with diarrhea
(2) hepatitis
(3) pancreatitis
(4) renal failure, which may be irrevesible
Laboratory findings:
(1) metabolic acidosis
(2) normal to high serum osmolality with high anion gap (HAGA = high anion gap metabolic acidosis)
A child may be symptomatic after a small exposure due to lower body size.
The presence of metabolic acidosis and acute renal failure should raise the possibility of diethylene glycol exposure.
