Journal of Medical Toxicology

, Volume 12, Issue 2, pp 172–179 | Cite as

Use of a Rapid Ethylene Glycol Assay: a 4-Year Retrospective Study at an Academic Medical Center

  • Sydney L. Rooney
  • Alexandra Ehlers
  • Cory Morris
  • Denny Drees
  • Scott R. Davis
  • Jeff Kulhavy
  • Matthew D. Krasowski
Original Article


Ethylene glycol (EG) is a common cause of toxic ingestions. Gas chromatography (GC)-based laboratory assays are the gold standard for diagnosing EG intoxication. However, GC requires specialized instrumentation and technical expertise that limits feasibility for many clinical laboratories. The objective of this retrospective study was to determine the utility of incorporating a rapid EG assay for management of cases with suspected EG poisoning. The University of Iowa Hospitals and Clinics core clinical laboratory adapted a veterinary EG assay (Catachem, Inc.) for the Roche Diagnostics cobas 8000 c502 analyzer and incorporated this assay in an osmolal gap-based algorithm for potential toxic alcohol/glycol ingestions. The main limitation is that high concentrations of propylene glycol (PG), while readily identifiable by reaction rate kinetics, can interfere with EG measurement. The clinical laboratory had the ability to perform GC for EG and PG, if needed. A total of 222 rapid EG and 24 EG/PG GC analyses were documented in 106 patient encounters. Of ten confirmed EG ingestions, eight cases were managed entirely with the rapid EG assay. PG interference was evident in 25 samples, leading to 8 GC analyses to rule out the presence of EG. Chart review of cases with negative rapid EG assay results showed no evidence of false negatives. The results of this study highlight the use of incorporating a rapid EG assay for the diagnosis and management of suspected EG toxicity by decreasing the reliance on GC. Future improvements would involve rapid EG assays that completely avoid interference by PG.


Enzymatic assay Ethylene glycol Glycols Gas chromatography Propylene glycol 



The authors gratefully thank Aaron Sadler, Dr. Kamisha Johnson-Davis, and Dr. Gwen McMillin (ARUP Laboratories, Salt Lake City, UT, USA) for helpful technical advice and assistance with setting up the rapid ethylene glycol assay.

Compliance with Ethical Standards

Conflicts of Interest

The authors all declare no conflicts of interest.

Sources of Funding

The authors thank the Department of Pathology (Dr. Nitin Karandikar, Department Executive Officer) for providing research funding for this study.


  1. 1.
    Mowry JB, Spyker DA, Cantilena Jr LR, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila). 2013;51(10):949–1229.CrossRefGoogle Scholar
  2. 2.
    Jammalamadaka D, Raissi S. Ethylene glycol, methanol and isopropyl alcohol intoxication. Am J Med Sci. 2010;339(3):276–81.CrossRefPubMedGoogle Scholar
  3. 3.
    McQuade DJ, Dargan PI, Wood DM. Challenges in the diagnosis of ethylene glycol poisoning. Ann Clin Biochem. 2014;51(Pt 2):167–78.CrossRefPubMedGoogle Scholar
  4. 4.
    Porter WH. Ethylene glycol poisoning: quintessential clinical toxicology; analytical conundrum. Clin Chim Acta. 2012;413(3–4):365–77.CrossRefPubMedGoogle Scholar
  5. 5.
    Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999;37(5):537–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Brent J, McMartin K, Phillips S, Burkhart KK, Donovan JW, Wells M, et al. Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group. N Engl J Med. 1999;340(11):832–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Dasgupta A, Blackwell W, Griego J, Malik S. Gas chromatographic-mass spectrometric identification and quantitation of ethylene glycol in serum after derivatization with perfluorooctanoyl chloride: a novel derivative. J Chromatogr B Biomed Appl. 1995;666(1):63–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Porter WH, Rutter PW. Improved GC-MS procedure for simultaneous measurement of ethylene glycol and glycolic acid. Clin Chem. 2010;56(12):1900–2.CrossRefPubMedGoogle Scholar
  9. 9.
    Yao HH, Porter WH. Simultaneous determination of ethylene glycol and its major toxic metabolite, glycolic acid, in serum by gas chromatography. Clin Chem. 1996;42(2):292–7.PubMedGoogle Scholar
  10. 10.
    Jones AW, Nilsson L, Gladh SA, Karlsson K, Beck-Friis J. 2,3-Butanediol in plasma from an alcoholic mistakenly identified as ethylene glycol by gas-chromatographic analysis. Clin Chem. 1991;37(8):1453–5.PubMedGoogle Scholar
  11. 11.
    Shoemaker JD, Lynch RE, Hoffmann JW, Sly WS. Misidentification of propionic acid as ethylene glycol in a patient with methylmalonic acidemia. J Pediatr. 1992;120(3):417–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Wu AH, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, et al. National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem. 2003;49(3):357–79.CrossRefPubMedGoogle Scholar
  13. 13.
    Eckfeldt JH, Light RT. Kinetic ethylene glycol assay with use of yeast alcohol dehydrogenase. Clin Chem. 1980;26(9):1278–80.PubMedGoogle Scholar
  14. 14.
    Hansson P, Masson P. Simple enzymatic screening assay for ethylene glycol (ethane-1,2-diol) in serum. Clin Chim Acta. 1989;182(1):95–101.CrossRefPubMedGoogle Scholar
  15. 15.
    Blandford DE, Desjardins PR. A rapid method for measurement of ethylene glycol. Clin Biochem. 1994;27(1):25–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Long H, Nelson LS, Hoffman RS. A rapid qualitative test for suspected ethylene glycol poisoning. Acad Emerg Med. 2008;15(7):688–90.CrossRefPubMedGoogle Scholar
  17. 17.
    Jialal I, Devaraj S. Laboratory diagnosis of ethylene glycol poisoning: the cup is half full? Am J Clin Pathol. 2011;136(2):165–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Juenke JM, Hardy L, McMillin GA, Horowitz GL. Rapid and specific quantification of ethylene glycol levels: adaptation of a commercial enzymatic assay to automated chemistry analyzers. Am J Clin Pathol. 2011;136(2):318–24.CrossRefPubMedGoogle Scholar
  19. 19.
    Standefer J, Blackwell W. Enzymatic method for measuring ethylene glycol with a centrifugal analyzer. Clin Chem. 1991;37(10 Pt 1):1734–6.PubMedGoogle Scholar
  20. 20.
    Scherk JR, Brainard BM, Collicutt NB, Bush SE, Almy FS, Koenig A. Preliminary evaluation of a quantitative ethylene glycol test in dogs and cats. J Vet Diagn Invest. 2013;25(2):219–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Fowles JR, Banton MI, Pottenger LH. A toxicological review of the propylene glycols. Crit Rev Toxicol. 2013;43(4):363–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Zar T, Graeber C, Perazella MA. Recognition, treatment, and prevention of propylene glycol toxicity. Semin Dial. 2007;20(3):217–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Chicella M, Jansen P, Parthiban A, Marlowe KF, Bencsath FA, Krueger KP, et al. Propylene glycol accumulation associated with continuous infusion of lorazepam in pediatric intensive care patients. Crit Care Med. 2002;30(12):2752–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Lim TY, Poole RL, Pageler NM. Propylene glycol toxicity in children. J Pediatr Pharmacol Ther. 2014;19(4):277–82.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Wilson KC, Reardon C, Theodore AC, Farber HW. Propylene glycol toxicity: a severe iatrogenic illness in ICU patients receiving IV benzodiazepines: a case series and prospective, observational pilot study. Chest. 2005;128(3):1674–81.CrossRefPubMedGoogle Scholar
  26. 26.
    Brooks DE, Wallace KL. Acute propylene glycol ingestion. J Toxicol Clin Toxicol. 2002;40(4):513–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Casazza JP, Freitas J, Stambuk D, Morgan MY, Veech RL. The measurement of d,l-2,3-butanediol in controls and patients with alcoholic cirrhosis. Adv Alcohol Subst Abuse. 1988;7(3–4):33–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Felver ME, Lakshmanan MR, Wolf S, Veech RL. The presence of 2,3-butanediol in the blood of chronic alcoholics admitted to an alcohol treatment center. Adv Exp Med Biol. 1980;132(1):229–35.PubMedGoogle Scholar
  29. 29.
    Kuehnle J, Holzbaur J. 2,3-Butanediol in serum of alcoholics. Lancet. 1983;2(8363):1369–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Rutstein DD, Veech RL, Nickerson RJ, Felver ME, Vernon AA, Needham LL, et al. 2,3-Butanediol: an unusual metabolite in the serum of severely alcoholic men during acute intoxication. Lancet. 1983;2(8349):534–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Krasowski MD, Wilcoxon RM, Miron J. A retrospective analysis of glycol and toxic alcohol ingestion: utility of anion and osmolal gaps. BMC Clin Pathol. 2012;12:1.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Krasowski MD, Chudzik D, Dolezal A, Steussy B, Gailey MP, Koch B, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center. BMC Med Inform Decis Mak. 2015;15(1):11.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Krasowski MD, Schriever A, Mathur G, Blau JL, Stauffer SL, Ford BA. Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research. J Pathol Inform. 2015;6:45.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Krasowski MD, Davis SR, Drees D, Morris C, Kulhavy J, Crone C, et al. Autoverification in a core clinical chemistry laboratory at an academic medical center. J Pathol Inform. 2014;5(1):13.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ehlers A, Morris C, Krasowski MD. A rapid analysis of plasma/serum ethylene and propylene glycol by headspace gas chromatography. Springerplus. 2013;2(1):203.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Khajuria A, Krahn J. Osmolality revisited—deriving and validating the best formula for calculated osmolality. Clin Biochem. 2005;38(6):514–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Darracq MA, Rentmeester LL, Clark RF, Tomaszewski CA, Schneir AB, Cantrell FL. Cost of hemodialysis versus fomepizole-only for treatment of ethylene glycol intoxication. Clin Toxicol (Phila). 2013;51(3):188.CrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2015

Authors and Affiliations

  • Sydney L. Rooney
    • 1
  • Alexandra Ehlers
    • 1
  • Cory Morris
    • 1
  • Denny Drees
    • 1
  • Scott R. Davis
    • 1
  • Jeff Kulhavy
    • 1
  • Matthew D. Krasowski
    • 1
  1. 1.Department of PathologyUniversity of Iowa Hospitals and ClinicsIowa CityUSA

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