Characteristics of toxic alcohol and glycol poisoning in the UK

2011 International Congress of the European Association of Poisons Centres and Clinical Toxicologists

Objective: Enquiries regarding poisoning with ethylene glycol or methanol are frequently referred to a consultant clinical toxicologist in the UK, because of diagnostic difficulty, severe toxicity or inconsistent availability of specific assays and antidotes. This prospective study was undertaken to investigate the epidemiology of systemic exposures reported to the National Poisons Information Service (NPIS), use of antidotes and their adverse effects. Methods: Details of systemic exposures to products containing toxic alcohols and glycols reported to NPIS were collected from 1 January 2010 to 30 June 2010 as part of an ongoing 12 month study and cases of significant exposure were followed up to obtain information on antidote use and patient outcome. Results: There were 244 enquiries about toxic alcohols over the 6 month period. One hundred and forty-nine (61%) enquiries originated from hospitals. Sixty-one per cent of patients were male and 8% were under 5 years of age. Exposures were mainly by ingestion (95%), occurred mainly at home (89%), with 55% of cases being accidental and 36% intentional. The most common products were surgical spirits, antifreeze and screenwash products with ethylene glycol identified as the most common ingredient. At the time of the enquiry 78% of patients had no or minor symptoms and 19% moderate/severe symptoms using the Poisons Severity Score. One hundred and three cases met the criteria for case follow up. Of the 60 cases where the outcome is known, 57 made a complete recovery and 3 had sequelae. Details of monitoring and treatments were available for 70 cases. Fomepizole was administered in 17 cases, ethanol 18 cases and both antidotes in 3 cases. Adverse reactions to the antidotes were reported in 3 cases where ethanol had been administered. Haemodialysis/filtration was instituted in 12 patients. Conclusion: Serious poisoning with toxic alcohol and glycols occurs infrequently although the incidence in the UK cannot be determined as some cases may not result in an enquiry to NPIS. Exposures are predominantly acute ingestions involving ethylene glycol and occur more frequently in males. The majority of patients show few symptoms at the time of the enquiry. Ethanol and fomepizole are used in similar numbers of patients without any differences in outcome. Acknowledgement: Submitted on behalf of the UK National Poisons Information Service.