eISSN: 2345-4202  
J Nephropharmacol. 2018;7(1):46-49.

Case Report

Proposed laboratory surrogate markers for the management of acute kidney injury in ethylene glycol poisoning in resource-challenged countries; a Mayo Clinic Health System, Wisconsin, case analysis

Macaulay Amechi Onuigbo 1,2, Eileen Samuel 2, Nneoma Agbasi 3, Adel Zurob 4

1 Mayo Clinic College of Medicine, Rochester, MN, USA
2 Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI, USA
3 North East London NHS Foundation Trust, United Kingdom
4 Department of Pulmonary Medicine, Mayo Clinic Health System, Eau Claire, WI, USA

Abstract

Mass poisonings with diethylene glycol (DEG) usually ingested as an unintended component of pharmaceutical preparations have occurred in Nigeria, especially affecting children with nearly 100% mortality outcomes. Clearly, the unavailability of Specialty Toxicology laboratory testing facilities translates to non-diagnosis and therefore inappropriate management of these patients with resulting poor outcomes. In this case analysis, while utilizing a case report involving intentional DEG intoxication that we managed at the Mayo Clinic Health System in North-Western Wisconsin, we have demonstrated the utility of serial values of commonly available blood test parameters including serum bicarbonate and anion gap, blood ABG pH and CO2 values, together with the use of serum osmolality gap as surrogates to expedite early and appropriate treatment of such cases even in the absence of Toxicology confirmation of DEG as the poisoning agent. Based on the experience gained from this case report, we strongly recommend that the responsible governments in resource-challenged countries must ensure that these laboratory surrogate indices, at the minimum, become available in the hospitals. This would improve outcomes in general.

Implication for health policy/practice/research/medical education:

Over the last several decades, mass poisonings of diethylene glycol (DEG), usually ingested as an unintended component of pharmaceutical preparations, have occurred in Nigeria, especially affecting children with nearly 100% mortality outcomes. The unavailability of toxicology laboratory testing facilities often translates to non-diagnosis and therefore inappropriate management of these patients. In this case analysis, we propose the utility and monitoring of serial values of commonly available blood test parameters such as serum bicarbonate and anion gap, blood ABG pH and CO2 values, together with the use of serum osmolality gap to expedite early and appropriate treatment of such cases. Moreover, it remains the obligate duty of the various governments in these countries to ensure the availability of requisitely necessary ancillary laboratory testing services in their areas of jurisdiction.

Please cite this paper as: Onuigbo MA, Samuel E, Agbasi N, Zurob A. Proposed laboratory surrogate markers for the management of acute kidney injury in ethylene glycol poisoning in resource-challenged countries; a Mayo Clinic Health System, Wisconsin, case analysis. J Nephropharmacol. 2018;7(1):46-49. DOI: 10.15171/npj.2018.11. 

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Submitted: 11 Oct 2017

Accepted: 15 Dec 2017
First published online: 05 Jan 2018
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