Transient non-cardiogenic pulmonary edema following massive ingestion of ethylene glycol butyl ether

Nicotinamide Mononucleotide Restores the Meiotic Competency of Porcine Oocytes Exposed to Ethylene Glycol Butyl Ether

Ethylene glycol butyl ether (EGBE), a type of glycol ethers, is a common chemical used in both industrial and household products. Increasing animal studies have indicated that it produces reproductive problems, such as testicular damage, reduced female fertility, death of embryos, and birth defects. However, how it influences the female germ cells has not yet determined. Here, we found that EGBE exposure resulted in the defective porcine oocyte maturation via disruption of cytoskeleton dynamics, showing the abnormal spindle assembly, chromosome alignment, and actin organization. Meanwhile, EGBE exposure perturbed the mitochondrial distribution and function, leading to the accumulation of reactive oxygen species (ROS) and generation of DNA damage and apoptosis. Of note, nicotinamide mononucleotide (NMN) supplementation rescued the meiotic defects caused by EGBE exposure via restoring NAD⁺ level and mitochondrial function and thus eliminating the excessive ROS. Taken together, our observations illustrate that NMN supplementation is an effective strategy to protect oocyte quality against environmental pollutant-induced deterioration, contributing to improve the animal and human fertility.

Pulmonary edema caused by inhalation of vapors from water-soluble paint

Aim

To report the effects of inhaling vapor from water‐soluble paint after a recent encounter with 16 patients treated in our emergency department.

Methods

We examined a series of chest computed tomography (CT) images from the 16 affected patients. Computed tomography was carried out on days 1, 2, 5, and 19 after the inhalation event.

Results

Twelve of the patients were found to have pulmonary edema, based on their CT findings. Patients with pulmonary edema were classified as its persisted period. In the severe group, its pulmonary edema persisted over 5 days include, exacerbated edema, delayed‐onset edema (during the follow‐up), or edema amelioration. One patient had exacerbated edema, three patients had delayed‐onset edema, and one patient experienced amelioration of their edema in the severe group. In all cases, the pulmonary edema had disappeared from the CT images by day 19 after the inhalation event. Thirteen of the 16 patients had a fever of ≥37°C. Three kinds of solutes (ethylene glycol, titanium dioxide, and silicon oxide) had been blended in the water‐soluble paint. The titanium dioxide was considered the probable cause of the pulmonary edema.

Conclusion

Inhalation of vapors from water‐soluble paints is considered relatively safe. However, our observations suggest that new lesions might develop and existing lesions could worsen, even if the edema is not severe immediately after the exposure. Thus, follow‐up imaging is needed for approximately 2 weeks in such cases.

Metabolic Acidosis Complicating Ingestion of Disinfectant Floor Cleaner Containing Butoxyethanol

Butoxyethanol intoxication has seldom been reported. We describe a case of ingestion of butoxyethanol-containing cleaner resulting in high anion gap metabolic acidosis, which resolved after treatment with ethanol and haemodialysis. The presentations and treatments of previous cases are highlighted. Discussion is centred on the toxicological pathway of butoxyethanol and the role of alcohol dehydrogenase inhibitor.

Acute toxicity classification for ethylene glycol mono-n-butyl ether under the Globally Harmonized System

Acute oral, dermal and inhalation toxicity classifications of chemicals under the United Nations Globally Harmonized System of Classification and Labelling of Chemicals (GHS) should typically be based on data from rats and rabbits, with the tacit assumption that such characterizations are valid for human risk. However this assumption is not appropriate in all cases. A case in point is the acute toxicity classification of ethylene glycol mono-n-butyl ether (EGBE, 2-butoxyethanol, CAS 111-76-2), where acute toxicity data from rats or rabbits leads to an overly conservative assessment of toxicity. Hemolysis is the primary response elicited in sensitive species following EGBE administration and the proximate toxicant in this response is 2-butoxyacetic acid (BAA), the major metabolite of EGBE. The sensitivity of erythrocytes to this effect varies between species; rats and rabbits are sensitive to BAA-mediated hemolysis, whereas humans and guinea pigs are not. In this publication, a weight of evidence approach for the acute hazard classification of EGBE under GHS is presented. The approach uses acute toxicity data from guinea pigs with supporting mechanistic and pharmacokinetic data in conjunction with human experience and shows that adopting the standard method results in over-classification.

Acute respiratory distress associated with inhaled hydrocarbon

BACKGROUND

Pneumonitis is a well-known complication following aspiration of ingested liquid hydrocarbons. There are few data about acute pulmonary toxicity from unintentional hydrocarbon inhalation; most human cases involve products containing a fluoropolymer in combination with hydrocarbons.

METHODS

Case report of a 45-year-old male who presented with respiratory distress after a 15-min inhalational exposure to a canvas waterproofing spray containing liquefied petroleum gas, ethylene glycol monobutyl ether, and isopropanol.

RESULTS

Patients had symptoms, exam findings, and chest X-ray that were consistent with an acute pneumonitis.

CONCLUSION

Acute pulmonary injury can occur after a short exposure to an inhaled hydrocarbon and associated symptoms appear to respond to supportive measures, including oxygen, corticosteroids, and bronchodilators.

Repeated ingestion of 2-butoxyethanol: case report and literature review

BACKGROUND

Ethylene glycol monobutyl ether (2-butoxyethanol) is not commonly associated with significant human poisoning. Exposures are usually through occupational contact and typically involve inhalation injury. Animal studies report severe hemolysis occurring in rats and mice. Rare published human cases give varied descriptions of the clinical course associated with 2-butoxyethanol poisoning including reports of metabolic acidosis, ethylene glycol production, oxaluria, renal failure, and anemia. We report a case of two separate ingestions (80 to 100 grams) of a glass cleaner concentrate containing 22% 2-butoxyethanol, and its primary metabolite butoxyacetic acid.

CASE REPORT

An 18-year-old male ingested 360-480 mL of 22% 2-butoxyethanol on two separate occasions. Approximately 10hours after the first ingestion, the patient developed severe CNS depression, metabolic acidosis, hematuria, and mild elevation of hepatic enzymes. He was treated initially with ethanol therapy but continued to deteriorate and was started on hemodialysis. Approximately 10 days after discharge, the patient ingested 480 mL of the same product and received ethanol and hemodialysis within four hours of ingestion. During his second admission the patient did not develop the delayed severe CNS depression or profound metabolic acidosis. Clinically significant hemolytic anemia, oxaluria, ethylene glycol production, and renal failure were not noted in either episode. The patient recovered on both occasions without sequelae.

CONCLUSION

Hemodialysis may be an effective treatment intervention for managing severe acute 2-butoxyethanol intoxication, however, further investigation is warranted.

Butoxyethanol ingestion with prolonged hyperchloremic metabolic acidosis treated with ethanol therapy

BACKGROUND

Severe toxic ingestions of butoxyethanol (CAS No. 111-76-2) are rare despite the prevalence of this glycol ether in products such as glass and surface cleaners. Manifestations of acute butoxyethanol toxicity include metabolic acidosis, hemolysis, hepatorenal dysfunction, and coma, but vary widely in reported cases. Furthermore, the optimal therapeutic approach is not yet established. Much of the toxicity of butoxyethanol has been ascribed to its aldehyde and acid metabolites which are similar to those produced by oxidative metabolism of methanol and ethylene glycol. Although the roles of alcohol dehydrogenase inhibition with ethanol or fomepizole and hemodialysis are clear in the case of toxic ingestions of methanol and ethylene glycol, they remain poorly defined for butoxyethanol poisoning.

CASE REPORT

We report the case of a 51-year-old female who ingested up to 8 ounces of Sanford Expo White Board Cleaner (butoxyethanol and isopropanol). She developed prolonged hyperchloremic metabolic acidosis and mental status depression and was treated with ethanol therapy but not hemodialysis. This patient recovered without apparent sequelae. The kinetics of butoxyethanol metabolism in this case are described and the potential therapeutic options are discussed.

Toxicokinetics of inhaled 2-butoxyethanol and its major metabolite, 2-butoxyacetic acid, in F344 rats and B6C3F1 mice

2-Butoxyethanol (2BE) is used extensively in the production of cleaning agents and solvents. It is primarily metabolized in the liver to 2-butoxyacetic acid (2BAA), which is believed to be responsible for 2BE toxicities associated with hemolysis of red blood cells. The objective of the study was to characterize the systemic disposition of 2BE and 2BAA in rats and mice during 2-year 2BE inhalation toxicity studies. Male and female F344 rats and B6C3F1 mice (6-7 weeks old) were exposed to target 2BE concentrations of 0, 31.2, 62.5, or 125 ppm (rats), or 0, 62.5, 125, or 250 ppm (mice), by whole-body inhalation for 6 h/day, 5 days/week for up to 18 months. Postexposure blood samples were collected after 1 day, 2 weeks, and 3, 6, 12, and 18 months of exposure. Postexposure 16-h urine samples were collected after 2 weeks and 3, 6, 12, and 18 months of exposure. A separate set of mice was kept in the control chamber and exposed to 2BE for 3 weeks when they were approximately 19 months old. Postexposure blood samples were collected after 1 day and 3 weeks of exposure and 16-h urine samples were collected after 2 weeks of exposure from these aged mice. Blood samples were analyzed for both 2BE and 2BAA and urine samples were analyzed for 2BAA using GC/MS, and their kinetic parameters were estimated through the curve-fitting method using SAS. Systemically absorbed 2BE was rapidly cleared from blood (t1/2-RAT < 10 min; t1/2-MOUSE < 5 min after the 1-day exposure) independent of exposure concentration. Proportional increases in AUC2BE relative to increases in exposure concentration indicated linear 2BE kinetics. In contrast, the rate of 2BAA elimination from blood decreased as the exposure concentration increased. Nonproportional increases in AUC2BAA also indicated that 2BAA is eliminated following dose-dependent, nonlinear kinetics. Overall, mice eliminated both 2BE and 2BAA from blood faster than rats. Sex-related differences in 2BAA elimination were most significant with rats, in that females were less efficient in clearing 2BAA from the blood. Differences in renal excretion of 2BAA are possibly responsible for the sex-related difference in the 2BAA blood profiles in rats. As exposure continued, the rates of elimination for both 2BE and 2BAA decreased in both species, resulting in longer residence times in the blood. When 19-month-old naive mice were exposed to 125 ppm, 2BE was rapidly cleared from the systemic circulation, exhibiting clearance profiles similar to young mice. However, old mice eliminated 2BAA from blood > 10 times slower than young mice after 1-day of exposure. This delayed elimination of 2BAA in old mice was less obvious after 3 weeks of exposure, suggesting that there might be other factors in addition to the age of animals that could influence the apparent difference in 2BAA kinetics between old and young mice. It was concluded that the elimination kinetics of 2BE and 2BAA following repeated 2BE exposure appear to be dependent on species, sex, age, time of exposure, as well as the exposure concentration.

Ethylene glycol poisoning: case report of a record-high level and a review

Ethylene glycol is commonly found in automobile antifreeze and a variety of other commercial products. Ingestion of ethylene glycol, either accidentally or in a suicide attempt, is characterized by severe acidosis, calcium oxalate crystal formation and deposition, and a wide variety of end organ effects that may be fatal. We present a case of a patient who ingested a massive amount of ethylene glycol in a suicide attempt and yet survived with minimal sequelae. A comprehensive review of the literature on the pathology and pathophysiology of ethylene glycol toxicity on each organ system is provided, along with information on diagnosis and current treatment recommendations.