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Emerging progressive atypical acute kidney injury in young children linked to ethylene glycol and diethylene glycol intoxication

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Abstract

Background

There had been a sudden surge of unusually severe and rapidly progressing acute kidney injury (AKI) incidence in Indonesia since August 2022 which did not correspond to the rise of COVID-19 incidence. We suspected this was related to ethylene glycol (EG) and diethylene glycol (DEG) intoxication. This study is aimed at describing the clinical and laboratory characteristics of AKI related to D(EG) intoxication in order to spread awareness of the possibility of intoxication in cases of rapidly progressing AKI with unknown etiology.

Methods

We conducted a cross-sectional study by collecting secondary data from the pediatric AKI registry at a national referral hospital in Jakarta, Indonesia. Data on children admitted from January to November 2022 with diagnosis of stage 3 AKI based on KDIGO criteria were included. Data regarding demographics, symptoms prior to anuria, laboratory results, infection panel including COVID-19 status, treatment administered, and mortality were analyzed.

Results

Sixteen patients tested positive for EG and DEG, all with history of consuming syrup-based medications. High anion gap metabolic acidosis was observed in majority of patients with mean pH 7.33 ± 0.07 and mean anion gap 15.6 ± 7.8 mEq/L. No patient had high osmolal gap (mean osmolal gap 3.46 ± 4.68). One deceased patient, who had kidney biopsy performed, showed severe damage and calcium oxalate crystals in the kidney tissue. Mortality was recorded in six patients (37.5%).

Conclusion

Careful history taking of patient’s clinical course, including consumption of syrup-based medications and laboratory findings, might aid clinicians to establish a working diagnosis of D(EG) intoxication without needing to wait for blood toxicology test. Early diagnosis and therapy are crucial to prevent substantial mortality.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We dedicated this work to the children and family who were affected by EG/DEG intoxication. Our greatest gratitude to all help from the Minister of Health Republic of Indonesia: Budi Gunadi Sadikin and his staff: Rizka Andalusia, The Indonesian Pediatric Society, the expert in Gambia and Melbourne: Prof Stephen Allen, Prof Vivian, Prof Julie Bines, Prof Trevor Duke, our hospital management: Fatima Safira Alatas, Sumariyono, Lies Dina Liastuti, and clinician team: Antonius Hocky Pudjiadi, Rismala Dewi, Irene Yuniar, Sharfina Fulki Adilla Hidayat, Mulya Rahma Karyanti, Teny Tjitra Sari, RA Setyo Handryastuti, Amanda Soebadi, Achmad Rafli, Pratama Wicaksana, and Fahreza Aditya Neldy.

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Authors and Affiliations

  1. Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

    Eka Laksmi Hidayati, Reza Fahlevi, Henny Adriani Puspitasari,  Tartila, Niken Wahyu Puspaningtyas, Fitri Primacakti, Yogi Prawira, Ari Prayitno, Sudung Oloan Pardede & Nina Dwi Putri

  2. Department of Pathological Anatomy, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

    Meilania Saraswati & Monik Ediana Miranda

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  1. Eka Laksmi Hidayati
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Correspondence to Eka Laksmi Hidayati.

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Hidayati, E.L., Fahlevi, R., Puspitasari, H.A. et al. Emerging progressive atypical acute kidney injury in young children linked to ethylene glycol and diethylene glycol intoxication. Pediatr Nephrol 39, 897–904 (2024). https://doi.org/10.1007/s00467-023-06157-9

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