Search by Outline Set Search Limits Advanced Search Back Home

Lab Test: Ethylene Glycol (Serum) Level

    Lab Test
    • Ethylene Glycol (Serum)
    Description
    • Measurement of ethylene glycol in serum or plasma for the evaluation of poisoning.
    • Ethylene glycol is used as a solvent, in antifreeze, industrial humectant, and hydraulic brake fluids, and as a glycerin substitute in commercial products such as paints, lacquers, detergents, and cosmetics.
    • It is colorless, odorless, but has a sweet taste.
    Reference Range
    • Toxic:  ≥ 20 mg/dL  or  (3 mmol/L)
    • Critical Levels:  ≥ 50 mg/dL
    • Fatal Levels: risk of death increases significantly above > 300 mg/dL
    Indications & Uses
    • Suspected ethylene glycol poisoning
    • Lethal Concentration:
      • An approximate lethal ethylene glycol dose in adults is approximately 100 cc; however, individuals reportedly have survived much higher doses. 
      • An estimated lethal oral ethylene glycol dose is 1.4 mL/kg or 1.56g/kg.
      • Death has been reported with ingestion of as little as 30 to 60 mL; however, survival has been reported with ingestion of more than 3,000 mL.
    • Ethylene glycol level may be undetectable due to conversion of the parent compound to toxic metabolites (glycoaldehyde, glycolate, glyoxalate, oxalate).
    Clinical Application
    • Similar to alcohol (ethyl alcohol) ingestion, patients can present with inebriation (intoxication)
    • Ingestion of ethylene glycol (120 mg/kg body weight or 0.1 mL/kg body weight) can result in a toxic concentration.
      • An approximate lethal ethylene glycol dose in adults is approximately 100 cc (or) 1.4 mL/kg or 1.56g/kg.
      • Death has been reported with ingestion of as little as 30 to 60 mL; however, survival has been reported with ingestion of more than 3,000 mL
    • Early on in ethylene glycol ingestion the serum osmolality and osmolar gap will be high, but will decrease as the ethylene glycol gets converted to glycolic acid, glyoxylic acid, and oxalic acid and cause an increase in the anion gap as well as metabolic acidosis.
    • An estimation of the ethylene glycol concentration can be made while waiting on the official level to come back from the lab by taking the osmolar gap and multiple by 6.2.
    • While this should not be relief upon for ruling in or out the presence of ethylene glycol toxicity, antifreeze contains fluorescein, which can be easily seen under a Wood's lamp in present in vomit or the urine.
    • Don't forget to monitor for calcium levels as it can decrease due to binding of oxalic acid and thus result in hypocalcemia.
    Related Tests
    • Anion gap
    • Serum Osmolality
    • Osmolar gap
    Drug-Lab Interactions
    • Ethylene glycol can interact with the assays that measure lactic acid, thereby causing higher lactic acid levels than actually present.
    Test Tube Needed
    • EDTA (ethylene diamine tetraacetic acid)
    Procedure
    • Collect plasma or draw serum blood sample.
    Storage and Handling
    • None
    What To Tell Patient Before & After
    • None
    References
    • Church AS et al. Laboratory testing in ethanol, methanol, ethylene glycol, and isopropanol toxicities. J Emerg Med 1997;15:687-92.
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.

MESH Terms & Keywords

    • Ethylene Glycol Level, Toxic Alcohol Level