title: Long-term renal and neurologic outcomes among survivors of diethylene glycol poisoning.
abstract: OBJECTIVE
  At least 13 medication-associated diethylene glycol (DEG) mass poisonings have occurred since 1937. To our knowledge, this is the first longitudinal study characterizing long-term health outcomes among survivors beyond the acute poisoning period.
  
  
  OBJECTIVE
  To characterize renal and neurologic outcomes among survivors of a 2006 DEG mass-poisoning event in Panama for 2 years after exposure.
  
  
  METHODS
  This prospective longitudinal study used descriptive statistics and mixed-effects repeated-measures analysis to evaluate DEG-poisoned survivors at 4 consecutive 6-month intervals (0, 6, 12, and 18 months). Case patients included outbreak survivors with a history of (1) ingestion of DEG-contaminated medication, (2) hospitalization for DEG poisoning, and (3) an unexplained serum creatinine level of 1.5 mg/dL or higher (to convert to micromoles per liter, multiply by 88.4) during acute illness or unexplained exacerbation of preexisting end-stage renal disease.
  
  
  METHODS
  Demographics, mortality, dialysis dependence, renal function, neurologic signs and symptoms, and nerve conduction studies.
  
  
  RESULTS
  Of the 32 patients enrolled, 5 (15.6%) died and 1 was lost to follow-up, leaving 26 patients at 18 months. Three (9.4%) missed 1 or more evaluations. The median age was 62 years (range, 15-88 years), and 59.4% were female. Three (9.4%) patients had preexisting renal failure. Enrollment evaluations occurred at a median of 108 days (range, 65-154 days) after acute illness. The median serum creatinine level for the 22 patients who were not dialysis dependent at time 0 was 5.9 mg/dL (range, 1.8-17.1 mg/dL) during acute illness and 1.8 mg/dL (range, 0.9-5.9 mg/dL) at time 0. Among non-dialysis-dependent patients, there were no significant differences in the log of serum creatinine or estimated glomerular filtration rate over time. The number of patients with subjective generalized weakness declined significantly over time (P < .001). A similar finding was observed for any sensory loss (P = .05). The most common deficits at enrollment were bilateral lower extremity numbness in 13 patients (40.6%) and peripheral facial nerve motor deficits in 7 (21.9%). All patients with neurologic deficits at enrollment demonstrated improvement in motor function over time. Among 28 patients (90.3%) with abnormal nerve conduction study findings at enrollment, 10 (35.7%) had motor axonal involvement, the most common primary abnormality.
  
  
  CONCLUSIONS
  Neurologic findings of survivors tended to improve over time. Renal function generally improved among non-dialysis-dependent patients between acute illness and the first evaluation with little variability thereafter. No evidence of delayed-onset neurologic or renal disease was observed.
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Laura
authors.initials: L
authors.lastname: Conklin
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kieszak
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Raquel
authors.initials: R
authors.lastname: Sabogal
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sanchez
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dana
authors.initials: D
authors.lastname: Flanders
authors.affiliation: Hospital Santo Tomás, Panama City, Panama.
authors.forename: Felicia
authors.initials: F
authors.lastname: Tulloch
authors.affiliation: Hospital Santo Tomás, Panama City, Panama.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Victoria
authors.affiliation: Caja de Seguro Social, Panama City, Panama.
authors.forename: Giselle
authors.initials: G
authors.lastname: Rodriguez
authors.affiliation: The Gorgas Memorial Institute, Panama City, Panama.
authors.forename: Nestor
authors.initials: N
authors.lastname: Sosa
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McGeehin
authors.affiliation: Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia6Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Schier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004340:Drug Contamination; D005026:Ethylene Glycols / Q000506:poisoning*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000453:epidemiology; D010176:Panama / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D005026:Ethylene Glycols; C013484:diethylene glycol