Diethylene glycol

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LogoKeyPointsBox.pngAcute kidney injury plus facial or limb weakness -> consider diethylene glycol poisoning

An odorless, sweet colourless syrupy liquid that kills. In 1937 when added to a sulfonamide it killed about 100 Americans and resulted in USA federal regulation of medicines manufacture that required safety testing. This has not stopped adulteration by the ignorant or malign of pharmaceuticals[1]. The lethal dose for human beings is as low as 0.014mg diethylene glycol/kg, but a single oral lethal dose is approximately 1.1 g/kg (1 mL/kg, but may be as high as 5g/kg or a pint for an adult). Skin absorption is possible[2]. It causes a metabolic acidosis, being metabolised to (2-hydroxyethoxy)acetaldehyde and then (2-hydroxyethoxy)acetate. 2-hydroxyethoxyacetic acid (HEAA) is the main suspected toxin. Some oxalate may be formed. Toxic symptoms include abdominal pain, nausea, vomiting, diarrhoea, dizziness, drowsiness, confusion, encephalopathy, multiple cranial and peripheral neuropathies[3] and coma[4].

As well as being used in antifreeze it is used widely in the chemical and plastics industry and for natural gas dehydration. It has been used for substance abuse as the first stage of toxicity results in inebriation.

Treatment of poisoning


  1. Schier JG, Rubin CS, Miller D, Barr D, McGeehin MA. Medication-associated diethylene glycol mass poisoning: a review and discussion on the origin of contamination. Journal of public health policy. 2009 Jul; 30(2):127-43.(Link to article – subscription may be required.)
  2. Devoti E, Marta E, Belotti E, Bregoli L, Liut F, Maiorca P, Mazzucotelli V, Cancarini G. Diethylene Glycol Poisoning From Transcutaneous Absorption. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2014 Nov 5.(Epub ahead of print) (Link to article – subscription may be required.)
  3. Imam YZ, Kamran S, Karim H, Elalamy O, Sokrab T, Osman Y, Deleu D. Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature. Medicine. 2014 Aug; 93(10):e62.(Link to article – subscription may be required.)
  4. Conklin L, Sejvar JJ, Kieszak S, Sabogal R, Sanchez C, Flanders D, Tulloch F, Victoria G, Rodriguez G, Sosa N, McGeehin MA, Schier JG. Long-term renal and neurologic outcomes among survivors of diethylene glycol poisoning. JAMA internal medicine. 2014 Jun; 174(6):912-7.(Link to article – subscription may be required.)
  5. Brent J. Fomepizole for the treatment of pediatric ethylene and diethylene glycol, butoxyethanol, and methanol poisonings. Clinical toxicology (Philadelphia, Pa.). 2010 Jun; 48(5):401-6.(Link to article – subscription may be required.)
  6. Schep LJ, Slaughter RJ, Temple WA, Beasley DM. Diethylene glycol poisoning. Clinical toxicology (Philadelphia, Pa.). 2009 Jul; 47(6):525-35.(Link to article – subscription may be required.)
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