Value of glycolic acid analysis in ethylene glycol poisoning: A clinical case report and systematic review of the literature

Gaspar Tuero; Jesús González; Laura Sahuquillo; Anna Freixa; Isabel Gomila; Miguel Ángel Elorza; Bernardino Barceló

doi:10.1016/j.forsciint.2018.07.007

Value of glycolic acid analysis in ethylene glycol poisoning: A clinical case report and systematic review of the literature

Forensic Sci Int. 2018 Sep:290:e9-e14. doi: 10.1016/j.forsciint.2018.07.007. Epub 2018 Jul 17.

Authors

Gaspar Tuero¹, Jesús González², Laura Sahuquillo³, Anna Freixa⁴, Isabel Gomila⁵, Miguel Ángel Elorza⁶, Bernardino Barceló⁷

Affiliations

¹ Department of Intensive Care Medicine, Hospital Can Misses, Corona, s/n, 07800 Ibiza, Spain. Electronic address: gtuero@asef.es.
² Department of Intensive Care Medicine, Hospital Can Misses, Corona, s/n, 07800 Ibiza, Spain. Electronic address: jgonzalez@asef.es.
³ Clinical Analysis Department, Hospital Can Misses, Corona, s/n, 07800 Ibiza, Spain. Electronic address: laurasf@asef.es.
⁴ Reference Laboratory, Pablo Iglesias, 57, 08908 L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: boliver@referencelaboratory.es.
⁵ Clinical Analysis Department, Hospital Universitari Son Llàtzer, Research Institute of Health Sciences (IdISBa), Ctra. de Manacor, 07198 Palma de Mallorca, Spain. Electronic address: isabel.gomila@hsll.es.
⁶ Clinical Toxicology Unit, Clinical Analysis Department, Hospital Universitari Son Espases, Ctra. de Valldemossa, 79, 07120 Palma de Mallorca, Spain. Electronic address: miguelangel.elorza@ssib.es.
⁷ Clinical Toxicology Unit, Clinical Analysis Department, Hospital Universitari Son Espases, Research Institute of Health Sciences (IdISBa), Ctra. de Valldemossa, 79, 07120 Palma de Mallorca, Spain. Electronic address: bernardino.barcelo@ssib.es.

PMID: 30055870
DOI: 10.1016/j.forsciint.2018.07.007

Abstract

Objective: To evaluate the clinical utility of glycolic acid (GA) determination in the diagnosis and prognosis of ethylene glycol (EG) intoxications.

Method: Systematic review of serum and/or urine GA concentrations available in the literature in cases of EG poisoning. Present a clinical case in which the determination of the GA was decisive.

Results: In total, 137 patients were included. Serum GA concentrations (but not EG) of patients who survive are different from those who die. The optimal cut-off of serum GA to predict mortality was 990.5mg/L (sensitivity 85.2%, specificity 54.3%) with an Odds Ratio of 6.838 (2.868-16.302). In our clinical case, serum EG was negative; however, urine GA was positive (1230.7mg/L).

Conclusions: In all suspected cases of EG poisoning, it is advisable to carry out the simultaneous analysis of EG and GA.

Keywords: Diagnosis; Ethylene glycol; Glycolic acid; Intoxication; Prognosis.

Publication types

Case Reports
Review
Systematic Review

MeSH terms

Biomarkers / blood
Biomarkers / urine
Ethylene Glycol / poisoning*
Gas Chromatography-Mass Spectrometry
Glycolates / blood*
Glycolates / urine*
Humans
Male
Middle Aged
Poisoning / diagnosis
Sensitivity and Specificity

Substances

Biomarkers
Glycolates
glycolic acid
Ethylene Glycol