Etiology And Pathophysiology
First synthesized in 1859, ethylene glycol became widely used during World War II as an engine coolant and antifreeze, and it continues to be used as such today.1 Accidental exposures in children and animals may occur, as this substance has a sweet taste unless treated with a bittering agent. Interestingly, the use of bittering agents has not been found to decrease the frequency or severity of ethylene glycol poisonings.17 Ethylene glycol is easily accessible to the public and has been implicated in suicidal ingestions.
Ethylene glycol is converted to glycolaldehyde by the enzyme alcohol dehydrogenase (ADH), which is then converted to glycolic acid by aldehyde dehydrogenase. Subsequent steps in the metabolic pathway result in the formation of glycolic acid, which is responsible for acidosis, glyoxylic acid, and, finally, oxalic acid.1,18
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