Antifreeze poisoning

Antifreeze is a technical fluid that provides, at low temperatures, normal operation of the cooling systems of internal combustion engines, 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 provide most of the coolants with their main component, ethylene glycol, acting on the human body as a neurovascular poison. Acute and deadly antifreeze poisoning occurs when it enters the gastrointestinal tract, chronic can develop when inhaling its vapors that penetrate the passenger compartment when a radiator malfunctions, even getting liquid on the skin is undesirable, but inhalation and percutaneous intoxication with ethylene glycol antifreeze is usually not dangerous for life.

[1], [2], [3]

Epidemiology

Statistics of chemical poisoning suggests that the vast majority of such incidents (˃80%) are random and more than 90% occur in countries with medium and low incomes. If in developed countries half of the accidental poisoning occurs in children, then in the European territory of the CIS most accidents of this kind occur with adults and alcohol and its substitutes act as a toxic substance. There is evidence that about 40% of ethylene glycol poisoning ends in the death of the injured, mainly due to untimely assistance provided.

[4], [5], [6], [7], [8], [9]

Causes of the antifreeze poisoning

By acute antifreeze poisoning leads to its deliberate ingestion by adults to achieve a state of intoxication. Sometimes it is accidentally mistaken for alcohol, it may be in the composition of counterfeit alcohol. The risk factors for such cases are alcohol dependence, an irresponsible attitude to one’s health and a willingness to “help yourself” to alcohol of unknown origin.

Sometimes antifreeze is taken orally for the purpose of committing suicide, in theory it can be a murder weapon, however, this happens very rarely.

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

Antifreeze can get inside by chance when servicing a car, but it is unlikely to be a large and deadly dose, rather, a few drops.

Inhalation poisoning usually occurs by chance, when a person has no idea about leakage and penetration of antifreeze fumes into the room where people are (most often in the car).

Antifreeze can enter the blood through damaged skin, such as a scratch or cut on the arm, however, the ingestion of technical fluid is fraught with death. Inhalation of its vapor and even penetration through damaged skin usually does not result in the death of the affected person.

The pathogenesis of coolant poisoning is not reliably described at present. It is believed that the brain phase is due to the toxic alcohol-like effect of ethylene glycol. The clinical picture in this stage is reminiscent of alcohol poisoning and indicates a violation of neurotransmitter transmission in brain tissues, causing an imbalance in the processes of arousal and inhibition — first, there is a predominance of arousal, then a narcotic and paralytic effect. The brain phase lasts from one to two days, when a lethal dose is consumed, the victim falls into a comatose state and dies without first aid in the first 24 hours. There may be an improvement, sometimes temporary, that does not guarantee recovery, since you can die in a few days from metabolic acidosis.

The oxidation of ethylene glycol occurs fairly quickly, it is absorbed into the systemic circulation from the alimentary canal during the first quarter of an hour from the moment of ingestion of the coolant, sometimes within five minutes it can be detected in the blood. An hour later, unchanged ethylene glycol is detected in the victim's urine. The maximum concentration is reached 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 a violation of tissue respiration. Moreover, they affect to a greater extent the substance of the brain, as well as vessels, heart, lungs, gradually transforming to oxalic acid, which, before decomposing to carbon dioxide and water, manages to cause significant damage to vital organs.

The second, hepatorenal phase, begins in different ways for everyone, usually in 2-5 hours, sometimes in two days and later, depending on the dose taken, the state of the liver and kidneys, the degree of their involvement in the toxic process. During this period, symptoms of lesions of these organs prevail. The ethylene glycol metabolite, oxalic acid, has a predominant effect in this stage of poisoning.

Based on the severity of symptoms and the consequences of poisoning, it was found that oral administration of an average of 50 to 100 ml of this substance can cause mild severity in an adult. When ingested in the digestive system from 100 to 150 ml of antifreeze causes acute intoxication of moderate severity, from 150 to 300 ml a severe form of intoxication develops. The lethal dose of antifreeze is on average a glass of technical fluid. Dosages are very conditional, based on the calculation that in the finished antifreeze contains from about 40-55% ethylene glycol. Concentrated antifreeze and a counterfeit, which may contain methyl alcohol, are caught. 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, one should take into account the weight of the victim, his individual reaction (there are known cases of fatal poisoning when using 50 ml of technical fluid). In terms of pure ethylene glycol, it is enough for an adult to consume 2 ml per kilogram of its own weight. It also matters the state of health of the victim, the presence of food in the stomach. Victims often use antifreeze mixed with vodka, water, tea, coffee. What matters is the chemical nature, the presence of impurities and additives, that is, the grade of antifreeze, the degree of its dilution, and so on.

[10]

Symptoms of the antifreeze poisoning

When ingesting a toxic dose of antifreeze, the first signs resemble a state of alcohol intoxication. The brain phase begins - technical fluid has entered the bloodstream and acts on the central nervous system. Depending on the amount of antifreeze ingested, the concentration of ethylene glycol in it, the degree of dilution, after approximately two to three hours, the person’s face and collar area reddens, the hyperemia can be seen on the mucous membranes. Later, the skin and mucous membranes become cyanotic - acquire a bluish tint. The victim looks pretty drunk: he has an unsteady gait, a stray tongue, while he is talkative and agitated, and the symptoms are increasing. The victim may complain of discomfort in the abdomen and lumbar region, the stomach can feel and be tense and swollen, and it reacts to palpation painfully. Gradually, the agitation is replaced by a decrease in the background of the mood, the victim looks inhibited and drowsy, there may be dizziness and headache, the neck muscles increase (he cannot touch his chest with his chin even with help), limbs. Appears vomiting, convulsions, confusion. The victim can sleep soundly and this dream 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 hard, noisy, rarely, the pulse also decreases. When the victim leaves the brain phase, he is tormented by intense thirst, after quenching of which vomiting often occurs. The brain phase can last up to two days, coma without providing medical care often leads to the death of the patient. When using doses insufficient for lethal outcome, the victim gradually begins to regain consciousness, and his condition becomes better, although the general malaise still persists. The onset improvement and the end of the severe manifestations of the brain phase is not a sign of a favorable outcome.

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

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

In addition to impaired urination, dry mouth and constant thirst, increased bleeding, pressure jumps, palpitations, vomiting, nausea, diarrhea, headache, muscle tics, ammonia smell from the mouth, lethargy, weakness, ulceration of the oral mucosa appear. The victim complains of colic in the epigastric and lumbar zone, right under the ribs. Observed hepatomegaly, organ tenderness to palpation, Pasternatsky pronounced symptom. The patient drinks a lot, but the urine practically does not move away, muddy consistency, with sediment. Edema in the patient is not observed. Laboratory tests show the development of uremia and acidosis.

Acute poisoning with antifreeze fumes leads to a feeling of lack of air, slow breathing, dizziness. The victim must go out into the fresh air or must be removed. If symptoms persist after some time, you should consult a doctor.

Chronic inhalation poisoning occurs during regular work with poisonous technical fluids in poorly ventilated rooms, that is, when safety measures are not followed. Manifested by shortness of breath, dizziness, frequent headaches, nausea, visual impairment, motor coordination, hypertension, tachycardia.

Antifreeze can cause an allergic reaction and irritation of the skin if it comes into contact with integral skin. Wash the area of contact with soap and water as soon as possible.

If the skin had a scratch or scratch, the ingress of coolant, of course, can cause discomfort, burning, even inflammation, but systemic antifreeze poisoning through a cut is impossible. Even if antifreeze got into a wound, then its amount will be clearly not enough for the development of general intoxication.

Poisoning antifreeze through the blood occurs by absorption into the systemic circulation from the gastrointestinal tract. Another way to get into the circulatory system in sufficient quantities, he can not. Cases of intravenous anti-freeze are not known.

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 lesions of the filtering and excretory organs of the liver and kidneys are manifested.

By severity distinguish mild poisoning, moderate and severe.

There are also the following types of poisoning: more easily flowing - inhalation and ingestion of antifreeze through the mouth, which is a mortal danger to the human body.

If technical fluid gets into the eyes and on the skin, even if it is damaged, it can cause negative consequences for the eyes, skin irritation, however, it is not poisoning of the whole organism.

[11], [12], [13]

Complications and consequences

According to the prevailing symptoms, there are two clinical stages of antifreeze poisoning: cerebral, when symptoms speak of central nervous system damage, and hepatorenal, characterized by signs of hepatic and renal dysfunction. The poison damages the endothelial membrane of the vessels, disrupts the blood supply to all organs and disrupts tissue respiration.

Poisoning with an impressive dose of antifreeze ingested without providing timely assistance can result in the death of the victim. Mild and moderate degrees of intoxication lead to serious disruption of all vital organs, especially renal function, which can take about six months to restore. Often, it is not possible to completely restore the normal functioning of the kidneys, and chronic renal failure subsequently develops. Damage to the brain can become irreversible, life-long neurological disorders can be a complication of antifreeze poisoning.

The extent of damage to internal organs can provide insight into the results of pathological studies of tissue samples taken from the dead as a result of the use of a lethal dose of antifreeze. Findings of histologists meet the clinical stages of poisoning. When a lethal outcome occurs in the brain stage of poisoning, the greatest injuries are found in brain tissues — edema and disruption of their structure, vascular blood supply, disruption of their integrity and, as a result, diffuse small hematomas. Already in the first stage, the blood vessels of the liver and kidneys are filled with blood, there is swelling, degenerative changes at the cellular level, multiple small foci of necrosis, and mineral deposits in the kidneys. In addition to these organs, the lungs and bronchi (edema, separate scattered infiltrates) were also less affected, the heart - individual small hematomas under its outer and inner membranes, the gastric mucous epithelium was hyperemic and covered with multiple hemorrhages.

At the onset of death in the hepatorenal stage, the vessels of the brain are still overflowing with blood, the tissues are swollen, congestion and multiple small hematomas are observed in the cortex; 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 found. In this phase, the patient dies from liver and kidney damage incompatible with life. Detection of waterborne dystrophy of hepatocytes, foci of their necrosis and fatty hepatosis; renal hyperplasia, edema of their parenchymal layer, multiple hemorrhages in it closer to the capsule, which is tense in these places and tightly soldered to the parenchyma. There are practically no gaps in the renal tubules 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, in the survivors of the victims the same organs are affected, only to a lesser extent, and any complication on their part can become a consequence of poisoning.

[14], [15], [16], [17],

Diagnostics of the antifreeze poisoning

In the field of view of medical workers, victims often fall into a rather serious condition, often unconscious. The sweetish alcohol-fume odor emanates from them, the clinical picture resembles a strong intoxication, which, in combination with an increased osmolarity index of blood plasma, makes it possible to suspect antifreeze poisoning. Complete blood count shows neutrophilic leukocytosis, accelerated erythrocyte sedimentation. In the analysis of urine traces of protein and blood, leukocytosis, granular and hyaline cylinders are found.

In order to establish the type of poisonous substance, the victim is subjected to chemical and toxicological studies of blood, urine, and gastric lavage. If there are residues of ingested fluid, examine it. With ethylene glycol poisoning on the first day, its presence can be determined in the blood and urine, on the second day - in the urine, on the third - it is no longer detected even at the trace level.

At a later stage, blood and urine tests indicate metabolic acidosis. The blood levels of urea and creatinine, high levels of neutrophils increase, the level of urea is low in the urine and calcium oxalate crystals are found. It is turbid, with sediment, pronounced acid reaction and high protein content. The victim usually has high blood pressure.

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

[18], [19]

Differential diagnosis

Differential diagnosis is carried out with poisoning by ethyl alcohol, methyl, 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 assistance is chemical toxicological and biochemical analyzes.

When a patient is admitted in a comatose state, they differentiate intoxications from a closed head injury, stroke, hypoglycemic, ketoacidotic, barbituric coma.

[20], [21], [22], [23],

Treatment of the antifreeze poisoning

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

However, first aid can and should be given even before the arrival of the doctors. What if I drank antifreeze? If the victim is conscious, and the poisoning has occurred recently, it is necessary to flush the stomach as quickly as possible. Give a large amount of water to drink (3-5 liters) or, even better, saline solution, made in proportions: a teaspoon of salt without the top in a glass of water. And cause vomiting.

You can give the victim enterosorbents (ataksil, enterosgel, activated carbon and others). They are used in the highest single dosage according to the instructions. Almost always in the home medicine cabinet there are tablets of activated carbon, which are not swallowed whole, but taken in the form of a water suspension, stirring 2-3 tablespoons of crushed tablets in a glass of water.

They also give a laxative to eliminate toxic substances from the intestines.

Often it is impossible to determine exactly what the victim used. If it is known that the poisoning liquid contained methyl alcohol or ethylene glycol, then first aid may consist in giving the victim 100 g of high-quality 40% alcohol, such as brandy or 1: 1 diluted with water, to drink to the victim. Using this antidote, you can slow down the absorption of ethylene glycol into the blood.

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

It remains to wait for the doctors, if the patient is unconscious, he is laid on his side, warmly covered and watched so that he does not suffocate when the tongue is squeezed or the vomit eases.

Further treatment is carried out in a medical institution. First aid includes intensive probe lavage of the stomach, removal of toxic substances from the body, exchange transfusions, 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 injected intravenously, which is also broken down by alcohol dehydrogenase, and faster than ethylene glycol, and thus, competing with a toxic substance, slows down its absorption.

As a general anti-toxic agent, 30% sodium thiosulfate from 50 to 100 ml can be administered intravenously, which, although not an antidote to ethylene glycol, but its diuretic effect (in the absence of renal insufficiency) would be useful.

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

The reduction of metabolic acidosis is carried out by injections of 5% sodium bicarbonate solution, it is administered in a volume of up to 1000 ml or orally, from two to seven grams of baking soda at one time.

When receiving more than 200 ml of antifreeze, hemodialysis is shown on the first day, sometimes in combination with hemosorption. When symptoms of cerebral edema or pronounced neurological disorders perform spinal puncture.

In order to neutralize the detrimental effect of oxalic acid and to remove residues of antifreeze from the lower intestines, magnesium sulfate is administered intravenously, a salt laxative, which has a parallel choleretic and diuretic effect. However, with the development of respiratory and / or renal insufficiency, such measures may aggravate the situation of the patient.

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

The patient is warmed, the weakening of the cardiac activity is stopped by cardiovascular drugs, if necessary, anticonvulsants are prescribed. In the second, hepatorenal stage, hemodialysis may be required. The most characteristic measures taken in case of antifreeze poisoning are the preservation and restoration of kidney activity. The patient is shown copious drinking, diuretics, when taken which should be monitored to compensate for the loss of fluid and electrolytes, introducing saline plasma-replacing solutions that compensate for the effects of diuresis.

For severe degrees of poisoning, physiotherapy is performed using magnetic waves, ultraviolet and laser radiation, as well as chemotherapy (electrochemical oxidation of toxic substances). Such techniques are used in the second stage of detoxification after hemodialysis, aimed at improving the patient’s immune status and improving the properties of the blood.

Accelerate the breakdown of toxic metabolites of ethylene glycol, regulate the composition of the blood and neutralize their harmful effects on the central nervous system B vitamins. 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) alternate every other day. Vitamin B3 (niacin) is also prescribed.

There is no specific treatment regimen, suitable procedures and drugs are selected individually, including nutrition, and during the recovery period physiotherapy treatment.

Treatment of antifreeze poisoning at home

In case of antifreeze poisoning, you should not rely on alternative treatment, emergency medical care is required in the hospital. In most cases, you will need a hardware blood purification, which is impossible to carry out at home. Before the arrival of the medical team, it is possible to provide the feasible first aid described above (gastric lavage, enterosorbent administration). In addition, alternative medicine offers as a first aid to give the victim a drink: two or three raw chicken egg proteins; 400-600ml sour milk or kefir; the same amount of jelly or plain whole milk.

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

Renal failure can be controlled with fresh pomegranate juice, squeezed just before use. Drink the juice must be daily for two months. A glass of juice is drunk in the morning and at night and another ¼ cup - after breakfast, lunch and dinner. Pomegranate juice restores the working condition of the kidneys, helps to remove toxic substances from them, normalizes the activity of the entire urinary system.

A simpler and cheaper method of restoring kidney function with the help of millet. A glass of cereal is thoroughly washed with warm water, poured into a glass jar with a capacity of three liters and poured to the top with boiling water. Leave the jar on the table, covering and wrapping a warm scarf. In a day a white suspension will appear in the water. It is poured into a cup and drunk without restrictions. When the liquid is over, again boiled water is poured into the same can and it is wrapped up until morning. Drink millet infusion as long as the drink does not change the 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 the rump with water so that it is only covered with water. When the sprouts hatch, water is drained, the sprouted grain is washed and dried on a towel. Porridge is cooked in the usual way, on water, without salt and sugar. Eat it without oil and milk, you can with cranberries. This porridge cleans the kidneys, strengthens bone tissue and has a hypotensive effect.

Herbal treatment of renal failure can also improve the general condition after antifreeze poisoning.

For example, an infusion of burdock root is prepared as follows. First boil, defend and filter the water to prepare the infusion. Then a silver coin or a spoon is placed into it for 4-5 hours. Dried burdock roots must be crushed in a mortar to a powder. A tablespoon of this powder is brewed with a glass of boiling prepared water and left to infuse overnight (10 hours). In the morning, filter and drink until the evening.

Any treatment should be continued for at least a month, but not more than two.

After antifreeze poisoning, you can spend a month course of liver cleaning with the help of dandelion root. To do this, the dried roots of the plant must be crushed in a powder in a mortar. A teaspoon of this powder must be taken daily four times a day, washed down with clean water.

Thistle, St. John's wort, oregano, calendula, chamomile are also used to clean the liver. Corn silk and burdock are used in the treatment of liver and kidneys.

Homeopathy

Homeopathic antidote for antifreeze poisoning is not available. In this case, homeopaths agree with the official medicine and recommend, first of all, to remove the poison from the body, that is, flush the stomach, induce vomiting, and do an enema. Considering the dangerous consequences of this poisoning, homeopathic preparations can be used only after discharge from the hospital to restore the function of the brain, liver, kidneys and other affected organs. Treatment must be prescribed by a homeopath individually according to the effects of the poisoning.

For example, for residual brain events in combination with renal insufficiency, Apis, Kokkulus, Nux vomica, Sekale can be prescribed, for liver and kidney injuries - Lycopodium, Sepia, liver failure - Sulfur, Helidonium.

Complex homeopathic preparations can help improve the functioning of the liver and kidneys:

• Berberis Homemakord, drops designed to improve the functions of the liver, kidneys and blood vessels on the background of metabolic disorders;
• Hepar Compositum is a complex drug that restores liver detoxification function, improves bile outflow, normalizes redox processes, and has a beneficial effect on general immunity, gastrointestinal and urinary tract;
• Coenzyme Compositum - a tissue metabolism regulator;
• Lepandra Compositum, Hepel - drugs that restore the function of the digestive organs;
• Ubiquinone Compositum - a means to normalize tissue respiration.

[24], [25], [26]

Prevention

Prevent poisoning with antifreeze can be subject to not too complicated rules.

Consumers should not consume technical fluid inside.

At home, antifreeze should be stored in its original packaging, so that there is no doubt about what it is and out of the reach of children.

Do not buy counterfeit alcoholic beverages and not treat themselves to drinks of unknown and dubious origin.

When handling toxic fluids, follow safety regulations.

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

In the production of antifreeze add components that give the liquid a repulsive taste and smell, as well as - causing an instant gag reflex when swallowed, however, do not affect the technical characteristics.

[27], [28], [29], [30], [31]

Forecast

The favorable outcome of antifreeze poisoning depends on many factors - the amount of fluid you drink, individual sensitivity, the health of the victim and the speed of care. Prompt professional medical assistance can save lives, even if severely poisoned.