title: Clinical Features of Reported Ethylene Glycol Exposures in the United States.
abstract: BACKGROUND
  Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.
  
  
  RESULTS
  Using the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.
  
  
  CONCLUSIONS
  Deaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Jobson
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hogan
authors.affiliation: Department of Biology, Duke Center for Systems Biology, Duke University, Durham, North Carolina, United States of America.
authors.forename: Colin S
authors.initials: CS
authors.lastname: Maxwell
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Yichun
authors.initials: Y
authors.lastname: Hu
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Hladik
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
authors.affiliation: Carolinas Poison Center, Carolinas Medical Center, Charlotte, North Carolina, United States of America.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Beuhler
authors.affiliation: University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina, United States of America.|UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: William F
authors.initials: WF
authors.lastname: Pendergraft
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003257:Consumer Product Safety; D003625:Data Collection; D016208:Databases, Factual; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011041:Poisoning / Q000453:epidemiology* / Q000517:prevention & control; D000644:Quaternary Ammonium Compounds / Q000737:chemistry*; D012189:Retrospective Studies; D012424:Rural Population; D013406:Suicide, Attempted; D014481:United States
chemical_list: D019855:Ethylene Glycol; D000644:Quaternary Ammonium Compounds; C043414:denatonium