Antifreeze poisoning

Antifreeze is a technical liquid that ensures normal operation of internal combustion engine cooling systems at subzero temperatures, preventing icing and damage to parts of mechanisms. It is an aqueous solution of glycols, glycerin, monohydric alcohols, dyes in different proportions, but the required technical characteristics and affordable price are provided to most cooling liquids by their main component - ethylene glycol, which acts on the human body as a neurovascular poison. Acute and fatal poisoning with antifreeze occurs when it gets into the gastrointestinal tract, chronic poisoning can develop when inhaling its vapors that penetrate the car interior when the radiator is faulty, even contact of the liquid with the skin is undesirable, but inhalation and transdermal intoxication with ethylene glycol antifreeze usually do not pose a danger to life.

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Epidemiology

Statistics on chemical poisonings show that the vast majority of such incidents (˃80%) are accidental and more than 90% occur in countries with middle and low incomes. While in developed countries half of accidental poisonings occur in children, in the European territory of the CIS most accidents of this kind occur in adults and the toxic substance is alcohol and its surrogates. There is evidence that about 40% of ethylene glycol poisonings end in the death of the victims, mainly due to untimely assistance.

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Causes antifreeze poisoning

Acute antifreeze poisoning is caused by intentional ingestion by adults to achieve a state of intoxication. Sometimes it is accidentally mistaken for alcohol, and it can be found in counterfeit alcohol. Risk factors for such cases include alcohol addiction, irresponsible attitude to one's health, and willingness to "treat" oneself to alcohol of unknown origin.

Antifreeze is sometimes taken internally for the purpose of committing suicide, and theoretically it could be used as a murder weapon, although this is extremely rare.

If antifreeze is accessible to children or animals, the cause of poisoning is simple curiosity, ignorance of the consequences and the sweet taste of the solution.

Antifreeze can get inside accidentally when servicing a car, but it is unlikely to be a large and deadly dose, more likely a few drops.

Inhalation poisoning usually occurs accidentally, when a person has no idea about leaks and the penetration of antifreeze vapors into a room where people are (most often, into the interior of a car).

Antifreeze can enter the bloodstream through damaged skin, such as a scratch or cut on the hand, but ingestion of the technical liquid can be fatal. Inhalation of its vapors and penetration even through damaged skin usually does not lead to death of the victim.

The pathogenesis of coolant poisoning has not been reliably described at present. It is believed that the cerebral phase is caused by the toxic alcohol-like effect of ethylene glycol. The clinical picture at this stage resembles alcohol poisoning and indicates a violation of neurotransmitter transmission in the brain tissues, causing an imbalance in excitation and inhibition processes - at first, excitation predominates, then narcotic and paralytic effects. The cerebral phase lasts from one to two days, when a lethal dose is consumed, the victim falls into a comatose state and dies without assistance within the first day. Improvement may occur, sometimes temporary, not guaranteeing recovery, since death can occur in a few days from metabolic acidosis.

Ethylene glycol oxidation occurs quite quickly, it is absorbed into the systemic bloodstream from the digestive tract within the first quarter of an hour from the moment of ingestion of the coolant, sometimes after five minutes it can be detected in the blood. And after an hour, unchanged ethylene glycol is detected in the victim's urine. The maximum concentration is achieved within 6-12 hours.

In the body, this component is metabolized by the enzyme alcohol dehydrogenase. All intermediate metabolites of ethylene glycol, except water, are toxic. Their main effect is disruption of tissue respiration. Moreover, they affect to a greater extent the substance of the brain, as well as blood vessels, heart, lungs, gradually transforming into oxalic acid, which, before decomposing into carbon dioxide and water, manages to cause significant damage to vital organs.

The second, hepatorenal phase, begins differently for everyone, usually after 2-5 hours, sometimes after two days or later, depending on the dose taken, the condition of the liver and kidneys, and the degree of their involvement in the toxic process. During this period, the symptoms of damage to these organs prevail. The predominant effect at this stage of poisoning is exerted by the metabolite of ethylene glycol - oxalic acid.

Based on the severity of symptoms and consequences of poisoning, it has been established that oral intake of an average of 50 to 100 ml of this substance can cause mild poisoning in an adult. When ingested, 100 to 150 ml of antifreeze causes acute intoxication of moderate severity, and 150 to 300 ml causes severe intoxication. A lethal dose of antifreeze is an average glass of technical fluid. Dosages are very conditional, based on the fact that ready-made antifreeze contains about 40-55% ethylene glycol. There is concentrated antifreeze and counterfeit antifreeze, which may contain methyl alcohol. There is also propylene glycol antifreeze, which is more expensive and relatively safe for humans (although it is also not intended for internal use).

In addition, it is necessary to take into account the weight of the victim, his individual reaction (there are known cases of fatal poisoning when consuming 50 ml of technical liquid). In terms of pure ethylene glycol, an adult needs to consume 2 ml per kilogram of his own weight. The health of the victim, the presence of food in the stomach are also important. Victims often consume antifreeze mixed with vodka, water, tea, coffee. The chemical nature, the presence of impurities and additives, that is, the type of antifreeze, the degree of its dilution, and so on, are important.

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Symptoms antifreeze poisoning

When a toxic dose of antifreeze is swallowed, the first signs resemble a state of alcoholic intoxication. The cerebral phase begins - the technical liquid has entered the blood and affects the central nervous system. Depending on the amount of antifreeze ingested, the concentration of ethylene glycol in it, the degree of dilution, after about two to three hours the victim's face and collar zone turn red, hyperemia can be seen on the mucous membranes. Later, the skin and mucous membranes become cyanotic - they acquire a bluish tint. The victim looks pretty drunk: he has an unsteady gait, a slurred tongue, but he is talkative and excited, and the symptoms increase. The victim may complain of discomfort in the abdomen and lumbar region, the abdomen may be tense and swollen to the touch, and reacts painfully to palpation. Gradually, agitation gives way to a decrease in mood, the victim looks inhibited and sleepy, there may be dizziness and headache, increased muscle tone in the neck (he cannot touch his chin to his chest even with outside help), and limbs. Vomiting, convulsions, and clouding of consciousness appear. The victim may fall into a deep sleep, and this sleep will turn into a coma. In severe cases, reflexes are reduced or absent, for example, pupillary, there may be involuntary urination and defecation, a decrease in body temperature. The patient breathes heavily, noisily, rarely, the pulse also slows down. When the victim comes out of the cerebral phase, he is tormented by severe thirst, after which vomiting often occurs. The cerebral phase can last up to two days, a coma without medical care often leads to the death of the patient. When consuming doses insufficient for a lethal outcome, the victim gradually begins to regain consciousness, and his condition improves, although general malaise remains. The onset of improvement and the end of severe manifestations of the cerebral phase is not a sign of a favorable outcome.

Then, on average, on the second to fifth day, and sometimes much later - after two to three weeks, renal and hepatic symptoms of antifreeze poisoning appear (hepatorenal phase), the prognosis of which depends on the degree of damage to these organs and their initial condition.

Symptoms often appear as an unexpectedly sharp decrease in the amount of urine excreted, quickly turning into urinary retention, due to which metabolites containing nitrogen are not excreted and are concentrated in the blood. The development of anuria is an extremely unfavorable prognostic sign.

In addition to urination problems, there is dry mouth and constant thirst, increased bleeding, pressure surges, palpitations, vomiting, nausea, diarrhea, headache, muscle tics, ammonia odor from the mouth, lethargy, weakness, ulceration of the oral mucosa. The victim complains of colic in the epigastric and lumbar region, on the right under the ribs. Hepatomegaly, organ pain upon palpation, and pronounced Pasternatsky's symptom are observed. The patient drinks a lot, but urine practically does not pass, it is cloudy, with sediment. The patient does not have edema. Laboratory tests show the development of uremia and acidosis.

Acute poisoning with antifreeze vapors leads to a feeling of shortness of breath, slow, wheezing breathing, and dizziness. The victim should go out into the fresh air or be taken out. If the symptoms persist after some time, you should consult a doctor.

Chronic inhalation poisoning occurs when working regularly with toxic technical liquids in poorly ventilated areas, i.e. when safety precautions are not observed. It manifests itself as difficulty breathing, dizziness, frequent headaches, nausea, visual impairment, movement coordination, hypertension, and tachycardia.

If antifreeze comes into contact with intact skin, it may cause an allergic reaction and skin irritation. The contact area should be washed with plenty of water and soap as soon as possible.

If there was a cut or scratch on the skin, then the coolant can certainly cause unpleasant sensations, burning, even inflammation, but systemic poisoning with antifreeze through a cut is impossible. Even if antifreeze got into the wound, its amount will clearly be insufficient for the development of general intoxication.

Antifreeze poisoning through the blood occurs by absorption into the systemic bloodstream from the gastrointestinal tract. It cannot enter the bloodstream in sufficient quantities in any other way. Cases of intravenous infusion of antifreeze are not known.

The stages or phases of poisoning correspond to the order of organ damage: cerebral, when the central nervous system is exposed to ethylene glycol, and hepatorenal, when symptoms of damage to the filtering and excretory organs – the liver and kidneys – appear.

Depending on the severity, poisoning is classified as mild, moderate and severe.

The following types of poisoning are also distinguished: the milder type is inhalation poisoning and ingestion of antifreeze through the mouth, which poses a mortal danger to the human body.

Contact of technical fluid with eyes and skin, even damaged skin, can cause negative consequences for vision, skin irritation, however, it does not constitute poisoning of the whole organism.

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Complications and consequences

According to the prevailing symptoms, there are two clinical stages of antifreeze poisoning: cerebral, when the symptoms indicate damage to the central nervous system, and hepatorenal, characterized by signs of liver and kidney dysfunction. The poison damages the endothelial membrane of blood vessels, disrupts the blood supply to all organs without exception and disrupts tissue respiration processes.

Poisoning with significant doses of antifreeze taken orally without timely assistance can result in the death of the victim. Mild and moderate intoxication lead to serious disruptions in the functioning of all vital organs, especially renal function, which may take about six months to recover. Often, it is not possible to fully restore normal kidney function, and chronic renal failure subsequently develops. Brain damage may become irreversible, and lifelong neurological disorders may become a complication of antifreeze poisoning.

The extent of damage to internal organs can be determined by the results of pathomorphological studies of tissue samples taken from people who died as a result of consuming a lethal dose of antifreeze. The histological findings correspond to the clinical stages of poisoning. When a fatal outcome occurs in the cerebral stage of poisoning, the greatest damage is found in the brain tissues - swelling and disruption of their structure, strong blood filling of the vessels, disruption of their integrity and, as a result, diffuse small hematomas. Already in the first stage, the vessels of the liver and kidneys are overfilled with blood, swelling, degenerative changes at the cellular level, multiple small foci of necrosis are observed, and mineral deposits in the kidneys. In addition to the organs named, the lungs and bronchi (swelling, individual scattered infiltrates), the heart - individual small hematomas under its outer and inner membranes, the mucous epithelium of the stomach is hyperemic and covered with multiple hemorrhages are also damaged to a lesser extent.

When death occurs in the hepatorenal stage, the brain vessels are still filled with blood, the tissues are edematous, congestion and multiple small hematomas in the cortex are observed; the lung parenchyma is edematous and foci of bronchopneumonia, multiple small hemorrhages under the inner cardiac membrane and catarrhal phenomena in the gastrointestinal tract are detected. In this phase, the patient dies from liver and kidney damage incompatible with life. Dropsy dystrophy of hepatocytes, foci of their necrosis and fatty hepatosis are detected; renal hyperplasia, edema of their parenchymatous layer, multiple hemorrhages in it closer to the capsule, which is tense in these places and tightly fused with the parenchyma. The lumens in the renal tubules are practically absent due to dropsy of the epithelium lining them, the loops of Henle do not function for the same reason. Mineral deposits are found in the kidneys.

Death is an extreme case; the surviving victims have the same organs affected, only to a lesser extent, and any complication on their part can be a consequence of poisoning.

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Diagnostics antifreeze poisoning

Victims often come to the attention of medical workers in a rather serious condition, often unconscious. They emit a sweetish alcoholic-fusel smell, the clinical picture resembles severe intoxication, which, in combination with an increased index of osmolarity of blood plasma, allows one to suspect poisoning with antifreeze. A complete blood count shows neutrophilic leukocytosis, accelerated sedimentation of erythrocytes. Traces of protein and blood, leukocytosis, granular and hyaline cylinders are found in the urine analysis.

In order to determine the type of toxic substance, the victim undergoes chemical-toxicological tests of blood, urine, and gastric lavage. If there are any remnants of the liquid ingested, it is examined. In cases of ethylene glycol poisoning, its presence can be detected in the blood and urine on the first day, in the urine on the second day, and on the third day it is no longer detectable even at a trace level.

In the late stage, blood and urine tests show signs of metabolic acidosis. The blood shows elevated urea and creatinine levels, high neutrophil counts, and low urea levels in the urine, with calcium oxalate crystals. It is cloudy, with sediment, a pronounced acid reaction, and a high protein content. The victim usually has elevated blood pressure.

To assess the general health of the victim, instrumental diagnostics may be prescribed - ultrasound examination of the liver and kidneys, electrocardiography, electroencephalography and other studies based on the symptoms.

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Differential diagnosis

Differential diagnostics are carried out with poisoning by ethyl alcohol, methyl alcohol, other non-food alcohols and technical liquids. At the initial stages of poisoning, the clinical symptoms of such poisonings are similar and the main criterion for choosing the tactics of providing assistance are chemical-toxicological and biochemical analyses.

When a patient is admitted in a comatose state, poisoning is differentiated from closed craniocerebral trauma, stroke, hypoglycemic, ketoacidotic, and barbiturate coma.

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Treatment antifreeze poisoning

Ethylene glycol, as well as counterfeit antifreeze, is a very toxic liquid, so if it is consumed internally, it is necessary to take the victim to a medical facility as quickly as possible.

However, first aid can and should be provided before the arrival of doctors. What to do if you drank antifreeze? If the victim is conscious and the poisoning occurred recently, it is necessary to wash out his stomach as quickly as possible. Give him a large amount of water to drink (3-5 liters) or, even better, a saline solution made in the proportions: a level teaspoon of salt per glass of water. And induce vomiting.

You can give the victim enterosorbents (ataxil, enterosgel, activated carbon, etc.). They are used in the highest single dose according to the instructions. Almost always in the home medicine cabinet there are tablets of activated carbon, which are not swallowed whole, but taken as an aqueous suspension, mixing 2-3 tablespoons of crushed tablets in a glass of water.

A laxative is also given to eliminate toxic substances from the intestines.

It is often impossible to determine exactly what the victim has consumed. If it is known that the poisonous liquid contained methyl alcohol or ethylene glycol, then first aid may consist of giving the victim 100 g of high-quality 40% alcohol to drink, such as cognac or food alcohol diluted 1:1 with water. Using such an antidote can slow down the absorption of ethylene glycol into the blood.

The victim is usually tormented by severe thirst; you can give him water in small portions.

All that remains is to wait for the doctors; if the patient is unconscious, he is laid on his side, covered warmly, and they make sure that he does not suffocate when his tongue sinks or he vomits.

Further treatment is carried out in a medical institution. First aid includes intensive gastric lavage, removal of toxic substances from the body, exchange blood transfusions, and supportive therapy.

Medicines are prescribed based on the results of chemical-toxicological studies and clinical symptoms of poisoning.

In the first days after poisoning, ethyl alcohol is administered intravenously, which is also broken down by alcohol dehydrogenase, and faster than ethylene glycol, and thus, competing with the toxic substance, helps to slow down its absorption.

As a general antitoxic agent, 30% sodium thiosulfate can be administered intravenously from 50 to 100 ml, which, although not an antidote to ethylene glycol, will be useful for its diuretic effect (in the absence of renal failure).

Also, for detoxification of the body and as a nutrient, a 40% glucose solution is administered, from 50 to 100 ml; a hypertonic glucose solution with insulin is also used.

Metabolic acidosis is treated with injections of 5% sodium bicarbonate solution, administered in a volume of up to 1000 ml or orally - from two to seven grams of baking soda at a time.

When taking more than 200 ml of antifreeze, hemodialysis is indicated in the first day, sometimes in combination with hemosorption. In case of symptoms of cerebral edema or pronounced neurological disorders, a spinal puncture is performed.

To neutralize the destructive effect of oxalic acid and remove the remnants of antifreeze from the lower intestines, magnesium sulfate is administered intravenously, a saline laxative that has a parallel choleretic and diuretic effect. However, with the development of respiratory and/or renal failure, such measures can worsen the patient's condition.

In case of respiratory disorders, the patient is provided with inhalation oxygen. Respiratory analeptics (caffeine, camphor) can be prescribed to restore the activity of the respiratory center in the brain.

The patient is warmed, the weakening of cardiac activity is stopped by cardiovascular drugs, if necessary, anticonvulsants are prescribed. In the second, hepatorenal stage, hemodialysis may be required. The most typical measures taken in case of antifreeze poisoning are the preservation and restoration of kidney function. The patient is shown plenty of fluids, diuretics, when taking which it is necessary to monitor the compensation of fluid and electrolyte loss, introducing saline plasma-substituting solutions that compensate for the effects of diuresis.

In severe cases of poisoning, physiohematotherapy is used using magnetic waves, ultraviolet and laser radiation, as well as chemohematotherapy (electrochemical oxidation of toxic substances). Such methods are used in the second stage of detoxification after hemodialysis, aimed at improving the patient's immune status and improving blood properties.

Vitamins of group B accelerate the breakdown of toxic metabolites of ethylene glycol, regulate blood composition and neutralize their harmful effect on the central nervous system. Patients are prescribed vitamin B9 (folic acid) in a daily dose of 200 to 600 mg. Intramuscular injections of vitamins B1 (1-2 ml per day) and B6 (2-10 ml per day) are alternated every other day. Vitamin B3 (niacin) is also prescribed.

There is no specific treatment regimen; appropriate procedures and medications are selected individually, including nutrition and, in the recovery period, physiotherapy.

Antifreeze poisoning treatment at home

In case of antifreeze poisoning, you should not rely on folk remedies; emergency medical care in a hospital setting is required. In most cases, hardware blood purification will be required, which is impossible to do at home. Before the medical team arrives, you can provide feasible first aid, as described above (gastric lavage, taking enterosorbents). In addition, folk medicine suggests giving the victim the following to drink as first aid: two or three raw chicken egg whites; 400-600 ml of yogurt or kefir; the same amount of jelly or regular whole milk.

Traditional methods of treatment will be relevant in the recovery period after antifreeze poisoning. For example, kidney function is often not fully restored.

Kidney failure can be treated with fresh pomegranate juice, squeezed immediately before use. Drink the juice daily for two months. Drink a glass of juice in the morning and at night, and another ¼ glass after breakfast, lunch and dinner. Pomegranate juice restores the kidneys to working condition, helps remove toxic substances from them, and normalizes the functioning of the entire urinary system.

A simpler and cheaper method of restoring kidney function with millet. A glass of cereal is thoroughly washed with warm water, poured into a three-liter glass jar and filled to the top with boiling water. Leave the jar on the table, covered and wrapped in a warm scarf. After 24 hours, a white suspension will appear in the water. Pour it into a cup and drink without restrictions. When the liquid runs out, pour boiling water into the same jar again and wrap it up until the morning. Drink the millet infusion until the drink changes its taste. Then take a new glass of millet and make an infusion with it.

You can cook porridge from sprouted millet. You need to sprout it yourself. To do this, pour water over the cereal until it is just covered with water. When the sprouts hatch, drain the water, rinse the sprouted cereal and dry it on a towel. Cook the porridge in the usual way, in water, without salt and sugar. You need to eat it without butter and milk, you can with cranberries. This porridge cleanses the kidneys, strengthens bone tissue and has a hypotensive effect.

Herbal treatment for kidney failure may also improve overall health after antifreeze poisoning.

For example, an infusion of burdock root is prepared as follows. First, boil, settle and filter the water for the infusion. Then place a silver coin or spoon in it for 4-5 hours. Dried burdock roots should be ground in a mortar to a powder state. A tablespoon of this powder is brewed with a glass of boiling prepared water and left to infuse overnight (for about 10 hours). In the morning, strain and drink before evening.

Any course of treatment should be continued for at least a month, but no more than two.

After antifreeze poisoning, you can do a month-long liver cleanse using dandelion root. To do this, the dried roots of the plant need to be ground into powder in a mortar. Take a teaspoon of this powder daily four times a day, washing it down with clean water.

Milk thistle, St. John's wort, oregano, calendula, and chamomile are also used to cleanse the liver. Corn silk and burdock are used to treat both the liver and kidneys.

Homeopathy

There is no homeopathic antidote for antifreeze poisoning. In this case, homeopaths agree with official medicine and recommend, first of all, removing the poison from the body, that is, washing the stomach, inducing vomiting, and doing an enema. Given the dangerous consequences of this poisoning, homeopathic preparations can only be used after discharge from the hospital to restore the function of the brain, liver, kidneys, and other affected organs. Treatment should be prescribed by a homeopathic doctor individually, depending on the consequences of the poisoning.

For example, in case of residual cerebral phenomena in combination with renal failure, Apis, Cocculus, Nux vomica, Secale can be prescribed; in case of liver and kidney damage – Lycopodium, Sepia; in case of liver failure – Sulphur, Chelidonium.

Complex homeopathic preparations can help improve liver and kidney function:

• Berberis Gommacord, drops designed to improve the functions of the liver, kidneys and blood vessels in the context of metabolic disorders;
• Gepar Compositum is a complex preparation that restores the detoxifying function of the liver, improves bile flow, normalizes oxidation-reduction processes, has a beneficial effect on the general immunity, gastrointestinal and urinary tract;
• Coenzyme Compositum is a regulator of tissue metabolism;
• Lepthandra Compositum, Hepel – drugs that restore the functions of the digestive organs;
• Ubiquinone Compositum is a remedy for normalizing tissue respiration.

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Prevention

You can prevent antifreeze poisoning by following some simple rules.

Consumers should not ingest the technical fluid.

At home, antifreeze should be stored in its original packaging, so that there is no doubt about what it is, and in places inaccessible to children.

Do not buy counterfeit alcoholic beverages or consume drinks of unknown or dubious origin.

When working with toxic liquids, observe safety regulations.

In production, it is necessary to ensure strict control over its consumption.

When producing antifreeze, add components that give the liquid a repulsive taste and smell, as well as those that cause an immediate gag reflex when swallowed, but do not affect the technical characteristics.

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Forecast

The favorable outcome of antifreeze poisoning depends on many factors - the amount of liquid consumed, individual sensitivity, the health of the victim and the speed of assistance. Timely professional medical care can save lives even in severe poisoning.