title: Use of a Rapid Ethylene Glycol Assay: a 4-Year Retrospective Study at an Academic Medical Center.
abstract: Ethylene glycol (EG) is a common cause of toxic ingestions. Gas chromatography (GC)-based laboratory assays are the gold standard for diagnosing EG intoxication. However, GC requires specialized instrumentation and technical expertise that limits feasibility for many clinical laboratories. The objective of this retrospective study was to determine the utility of incorporating a rapid EG assay for management of cases with suspected EG poisoning. The University of Iowa Hospitals and Clinics core clinical laboratory adapted a veterinary EG assay (Catachem, Inc.) for the Roche Diagnostics cobas 8000 c502 analyzer and incorporated this assay in an osmolal gap-based algorithm for potential toxic alcohol/glycol ingestions. The main limitation is that high concentrations of propylene glycol (PG), while readily identifiable by reaction rate kinetics, can interfere with EG measurement. The clinical laboratory had the ability to perform GC for EG and PG, if needed. A total of 222 rapid EG and 24 EG/PG GC analyses were documented in 106 patient encounters. Of ten confirmed EG ingestions, eight cases were managed entirely with the rapid EG assay. PG interference was evident in 25 samples, leading to 8 GC analyses to rule out the presence of EG. Chart review of cases with negative rapid EG assay results showed no evidence of false negatives. The results of this study highlight the use of incorporating a rapid EG assay for the diagnosis and management of suspected EG toxicity by decreasing the reliance on GC. Future improvements would involve rapid EG assays that completely avoid interference by PG.
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Sydney L
authors.initials: SL
authors.lastname: Rooney
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ehlers
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Morris
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Denny
authors.initials: D
authors.lastname: Drees
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Davis
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Kulhavy
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA. mkrasows@healthcare.uiowa.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000046:Academic Medical Centers; D000465:Algorithms; D003937:Diagnosis, Differential; D057286:Electronic Health Records; D019855:Ethylene Glycol / Q000097:blood / Q000506:poisoning; D005410:Flame Ionization / Q000191:economics; D017721:Hospital Costs; D007484:Iowa; D011041:Poisoning / Q000097:blood / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000191:economics; D019946:Propylene Glycol / Q000097:blood / Q000506:poisoning; D011933:Reagent Kits, Diagnostic / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D066007:Toxicokinetics
chemical_list: D019855:Ethylene Glycol; D019946:Propylene Glycol; D011933:Reagent Kits, Diagnostic
keywords: Enzymatic assay; Ethylene glycol; Gas chromatography; Glycols; Propylene glycol