Inhalation and epidermal exposure of volunteers to ethylene glycol: kinetics of absorption, urinary excretion, and metabolism to glycolate and oxalate

G.KebedeSofiaKielsteinJan T.LewingtonAndrewLiYiMacedoEtienne M.MacLarenRobMowryJames B.NolinThomas D.OstermannMarliesPengAiRoyJean-PhilippeShepherdGreeneVijayanAnithaWalshSteven J.WongAnselmYatesChristopher, Anseeuw K, Berling I, Bouchard J, Bunchman TE, Calello DP, Chin PK, Doi K, Galvao T, Goldfarb DS, Hoegberg LCG, Kebede S, Kielstein JT, Lewington A, Li Y, Macedo EM, MacLaren R, Mowry JB, Nolin TD, Ostermann M, Peng A, Roy JP, Shepherd G, Vijayan A, Walsh SJ, Wong A, Yates C, for the EXTRIP Workgroup. Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid-base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong ("we recommend") or weak/conditional ("we suggest"), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8-12 mmol/L or anion gap 23-27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.

A toxicological review of the ethylene glycol series: Commonalities and differences in toxicity and modes of action

This review summarizes the hazards, exposure and risk that are associated with ethylene glycols (EGs) in their intended applications. Ethylene glycol (EG; CAS RN 107-21-1) and its related oligomers include mono-, di-, tri-, tetra-, and penta-EG. All of the EGs are quickly and extensively absorbed following ingestion and inhalation, but not by the dermal route. Metabolism involves oxidation to the mono- and dicarboxylic acids. Elimination is primarily through the urine as the parent compound or the monoacid, and, in the case of EG, also as exhaled carbon dioxide. All EGs exert acute toxicity in a similar manner, characterized by CNS depression and metabolic acidosis in humans and rodents; the larger molecules being proportionally less acutely toxic on a strict mg/kg basis. Species differences exist in the metabolism and distribution of toxic metabolites, particularly with the formation of glycolic acids and oxalates (OX) from EG and diethylene glycol (DEG); OX are not formed to a significant degree in higher ethylene glycols. Among rodents, rats are more sensitive than mice, and males more sensitive than females to the acute and repeated-dose toxicity of EG. The metabolic formation of glycolic acid (GA), diglycolic acid (DGA), and OX are associated with nephrotoxicity in humans and rodents following single and repeated exposures. However, physiological and metabolic differences in the rate of formation of GA, DGA and OX and their distribution result in EG and DEG causing embryotoxicity in rats, but not rabbits. This rodent-specific sensitivity indicates that EG and its higher oligomers are not anticipated to be embryotoxic in humans at environmentally relevant doses. None of the compounds present developmental toxicity concerns at doses that do not also cause significant maternal toxicity, nor do any of the EGs cause adverse effects on fertility. The EGs are neither genotoxic nor carcinogenic. A read-across matrix is presented, which considers the common and distinct toxicological properties of each compound. It is concluded that EGs pose no risk to human health as a result of their intended use patterns.

Phytoremediation of Mono-, Di-, and Triethylene Glycol by Echinodorus cordifolius L. Griseb

Mono-, di-, and triethylene glycol are chemicals used in various industrial (polyester products, plasticizers, printing, etc.) and domestic settings. The toxicity of these compounds is relatively low, but they do pose risks to the environment. Phytoremediation of the three glycols by Echinodorus cordifolius L. Griseb. were studied. The glycols were degraded in the leaves and roots, but leaves were the main source of degradation. The results of this study indicate that the plant can degrade triethylene glycol to diethylene glycol, diethylene glycol to 1,4-dioxan-2-one, or even further to monoethylene glycol. Moreover, 2-methoxy-4-vinylphenol, 1,2-cyclopentanedione, 1,4:3,6-dianhydro-.alpha.-d-glucopyranose, 2-propenamide, and 2,5-anhydro-1,6-dideoxyhexo-3,4-diulose were produced by this plant in response to the glycols.

Hazardous substances in frequently used professional cleaning products

Background:

A growing number of studies have identified cleaners as a group at risk for adverse health effects of the skin and the respiratory tract. Chemical substances present in cleaning products could be responsible for these effects. Currently, only limited information is available about irritant and health hazardous chemical substances found in cleaning products. We hypothesized that chemical substances present in cleaning products are known health hazardous substances that might be involved in adverse health effects of the skin and the respiratory tract.

Methods:

We performed a systematic review of cleaning products used in the Swiss cleaning sector. We surveyed Swiss professional cleaning companies (n = 1476) to identify the most used products (n = 105) for inclusion. Safety data sheets (SDSs) were reviewed and hazardous substances present in cleaning products were tabulated with current European and global harmonized system hazard labels.

Results:

Professional cleaning products are mixtures of substances (arithmetic mean 3.5±2.8), and more than 132 different chemical substances were identified in 105 products. The main groups of chemicals were fragrances, glycol ethers, surfactants, solvents; and to a lesser extent, phosphates, salts, detergents, pH-stabilizers, acids, and bases. Up to 75% of products contained irritant (Xi), 64% harmful (Xn) and 28% corrosive (C) labeled substances. Hazards for eyes (59%) and skin (50%), and hazards by ingestion (60%) were the most reported.

Conclusions:

Cleaning products potentially give rise to simultaneous exposures to different chemical substances. As professional cleaners represent a large workforce, and cleaning products are widely used, it is a major public health issue to better understand these exposures. The list of substances provided in this study contains important information for future occupational exposure assessment studies.

Phytoremediation of ethylene glycol and its derivatives by the burhead plant (Echinodorus cordifolius (L.)): effect of molecular size

Ethylene glycol (EG) is a group of dihydroxy alcohol that has been utilised in a variety of industrial and residential settings. EG contaminated wastewater has a high chemical oxygen demand (COD), which causes environmental problems. The aim of this research was to investigate the efficiency of the burhead plant (Echinodorus cordifolius (L.)) in the removal of mono-, di- and triethylene glycol (MEG, DEG and TEG), the first three members of the dihydroxy alcohol group, from synthetic wastewaters, to examine the toxic effect of EG on the plant and to identify differences among MEG, DEG, and TEG removal. It was found that the COD of synthetic wastewaters decreased to levels below the standard effluent (COD=120 mg L⁻¹) on day 18, 21 and 33 for MEG, DEG and TEG, respectively. On day 18 of the experiment, the burhead plant removed approximately 2000, 1950 and 730 mg L⁻¹ of MEG, DEG and TEG, respectively. The removal rate of MEG was faster than that of DEG and TEG, suggesting that the molecular size of the EG had affected its rate of removal. The concentrations of MEG, DEG, and TEG in plant tissue were measured to show that burhead can take up EG, and the major site of EG accumulation is the leaf. The molar of MEG that was taken up into the plant leaf was higher than that of DEG and TEG. This suggested that EG of smaller molecular sizes can be taken up more rapidly by the plant than EG of larger molecular sizes. EG concentrations in the leaf increased to a peak concentration and then slowly decreased. GC-MS analysis of DEG-treated plant tissue found MEG, 1,4-dioxan-2-one, neophytadiene, and 2-propenamide, that may be DEG-degradation products and/or compounds that are induced when plants are exposed to DEG. The result indicates that burhead can potentially be used for EG removal.

Dermal penetration of ethylene glycol through human skin in vitro

This study was conducted to determine the in vitro dermal absorption of ethylene glycol (EG) through dermatomed human abdominal skin (containing epidermis and dermis), obtained from cadavers within 24 hours of death and kept frozen until processed. Three formulations of EG (neat, 50%, and 10% aqueous solutions) were applied in triplicate to skin samples from 6 donors, and placed in Teflon Bronaugh flow-through diffusion cells. Barrier integrity of each sample was evaluated with (3)H-H(2)O prior to applying EG and only data from samples passing the test were used. A physiological receptor fluid was pumped beneath the skin samples and collected in a fraction collector at predetermined time points through 24 hours. Possible volatilized EG was trapped in a charcoal basket located above each skin sample. Each skin sample was treated with an infinite dose of 500 microL of EG formulation/cm(2). At the end of 24 hours, volatilized EG trapped in the headspace was collected, the unabsorbed dose was removed from the skin and the skin was rinsed, tape stripped, and solubilized along with a rinse of the flow-through cells, and total radioactivity was determined. Only a small fraction (</=1%) of the applied EG was absorbed in 24 hours, of which <0.7% penetrated through the skin and ~0.4% remained in the skin. Recovery (mass balance) of the applied EG was between 93% and 99%, which further validated the observed low dermal penetration of EG. The net penetration of the applied EG over 24 hours was concentration proportional, comprising 2.97 +/- 0.78, 1.75 +/- 0.62, and 0.23 +/- 0.12 mg/cm(2) of the neat, 50%, and 10% formulations, respectively. The steady-state flux of EG was established between 16 and 24 hours. The mean steady-state flux of EG through dermatomed skin was 217, 129, and 15 microg/cm(2)h for the neat, 50%, and 10% aqueous formulations, respectively, consistent with concentration-proportional penetration of EG. The steady-state permeation coefficient (Kp) for EG was low, between 1.5 x 10(-4) and 2.6 x 10(-4) cm/h. These findings demonstrate that EG dermal penetration is expected to be very low and to be slow, indicating very limited systemic or internal dose of EG due to dermal exposure.

Contaminated soils (III): in vitro dermal absorption of ethylene glycol and nonylphenol in human skin

Dermal absorption of contaminants from soils at federal contaminated sites in Canada was investigated using one hydrophile, (14)C-ethylene glycol (EG), and one lipophile, (14)C-nonylphenol (NP). In vitro dermal absorption of EG and NP was examined in dermatomed (0.4-0.5 mm) human skin using Bronaugh Teflon flow-through cells with Hanks HEPES buffered (pH 7.4) receiver solution with 4% bovine serum albumin (BSA). Tests were conducted under occlusive conditions with and without a commercial gardening soil spiked with EG or NP applied to skin at a soil load of 5 mg/cm(2). With percent absorption in skin depot included, a total of 9.9 + or - 6.28% (n = 6) and 34.8 + or - 8.47% (n = 6) absorption of EG with and without soil, respectively, and 20.6 + or - 5.56% (n = 7) and 41.1 + or - 6.46% (n = 7) of NP, with and without soil, respectively, were obtained. For tests without soil a reverse pattern was observed with significantly lower percent absorption into the receiver than depot with the lipophile NP, but significantly higher percent absorption in receiver versus depot for the hydrophile EG. This pattern was different in tests with soil, and caution needs to be exercised when extrapolating data from in vitro tests conducted without soil in human health risk assessments at contaminated sites.