Diglycolic acid is associated with diethylene glycol poisoning in humans Público

Abstract

In 2006, an outbreak of diethylene glycol (DEG) poisoning occurred in Panama. Biological samples from case and control patients enrolled in a study were shipped to Centers for Disease Control and Prevention (CDC) laboratories. After the outbreak was halted, samples were stored at CDC until 2009 when this study began. Our primary objective was to characterize the relationship between DEG and its toxic metabolites in biological samples collected from study participants. Serum and urine samples from cases and controls that had sufficient remaining volume were analyzed for DEG and its known toxic metabolites hydroxyethoxyacetic acid (HEAA) and diglycolic acid (DGA). Ethylene glycol (EG) and its toxic metabolites glycolic acid (GA) and oxalic acid (OA) were also measured. Analytes were measured using low resolution GC/MS. Detection frequencies and descriptive statistics were calculated. The Wilcoxon Rank Sum test (with exact p-values) and bivariable exact logistic regression were used in SAS v9.2 to analyze the data. Cerebrospinal fluid (CSF) samples from eight cases who developed neurotoxicity were also analyzed. Twenty case and 20 control serum samples along with 11 case and 22 control urine samples were analyzed. One case had insufficient urine volume to determine GA, HEAA and DGA concentrations. Notable results included detection of DGA in serum of all cases (median, 40.7 mcg/mL; range, 22.6-75.2) and no controls, and in the urine of all cases (median, 28.7 mcg/mL; range, 14-118.4) and only five (23%) controls (median, 999; exact p<0.0009); and 3) urinary DGA (OR=0.057; 95%CI=0.001-0.55). Cerebrospinal fluid DGA concentrations were detected in 7 (88%) of CSF samples (median, 2.03 mcg/mL; range,

Table of Contents

Table of Contents

Introduction 1-3

Methods 3-7

Results 7-9

Discussion 9-12

Limitations 12-13

Conclusion 13-14

References 15-17

Tables 18-21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Toxicology
Palabra Clave	poisoning diethylene glycol diglycolic acid hydroxyethoxyacetic acid
Committee Chair / Thesis Advisor	Flanders, W Dana, Emory University
Partnering Agencies	Industrial or Commercial (for-profit) organization CDC

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