Diethylene glycol poisoning from transcutaneous absorption: Case report

Abstract

Diethylene glycol (DEG) has been implicated in several cases of poisoning over the years. The most common mechanism of poisoning is accidental or deliberate ingestion of anti-freezer; however, poisoning from transcutaneous absorption is extremely rare. Treatment is not well defined but fomepizole or ethanol can be an effective antidote specially if started early. Furthermore, early hemodialysis will reduce the burden of toxic metabolites. Here, we report a rare case of diethylene glycol poisoning from transcutaneous absorption. Our patient presented complaining of gastrointestinal and renal symptoms. Initial laboratory results showed values consistent with acute kidney injury and metabolic acidosis. Therefore, hemodialysis was started right away. On the 7th day of admission, the patient started showing features suggestive of impending respiratory failure which prompted a transfer to intensive care unit (ICU) for mechanical ventilation. After ICU admission, the patient’s family reported previously concealed history of the patient applying brake fluid, a substance containing diethylene glycol, as traditional remedy for rash. Unfortunately, at that time, the antidote for diethylene glycol poisoning was not available in our country, Ethiopia. Hence, supportive treatment alone was given. Regrettably, the patient died on the 12th day of ICU admission. This case represents the unique clinical aspects of DEG poisoning. It also underscores the importance of suspecting DEG poisoning in acute renal failure patients with poor response to hemodialysis. Furthermore, taking detailed history will provide the initial clue to consider DEG poisoning. Lastly, further study should be done to identify factors that determine the occurrence of DEG poisoning from cutaneous brake fluid exposure.