Understanding Ethylene Glycol Toxicity: How Alcohol Can Save Lives
In this episode of Vetsplanation, Dr. Sugerman discusses the dangers of ethylene glycol toxicity in pets and how it can be potentially fatal. He explains how ethylene glycol is commonly found in antifreeze and other household products, and its sweet taste can attract pets to ingest it. Dr. Sugerman also talks about the symptoms of ethylene glycol toxicity, the importance of early diagnosis and treatment, and the prognosis for recovery. Tune in to learn more about this deadly toxin and how to keep your pets safe.
What You’ll Learn:
Ethylene glycol toxicity and its effects on pets
The sources and uses of ethylene glycol, including antifreeze and other household products
The attractiveness of ethylene glycol to pets due to its sweet taste
Symptoms of ethylene glycol poisoning, including drunken behavior, vomiting, and wobbliness
The rapid absorption of ethylene glycol in the body
Organ damage caused by ethylene glycol, particularly to the kidneys and blood
Diagnosis and diagnostic tests for ethylene glycol toxicity, including blood work and urinalysis
Treatment options, including hospitalization, IV fluids, and medications like fomepizole and ethanol
Prognosis and potential complications of ethylene glycol toxicity
Commonly asked questions about ethylene glycol toxicity, such as the use of charcoal and pet-safe antifreeze
Ideas Worth Sharing:
"That mystery liquid could be something very deadly. So listen in as we discuss ethylene glycol toxicity and how alcohol can actually save lives.” - Dr. Tyler Sugerman
“Any animal can get ethylene glycol toxicity. But dogs and cats are especially vulnerable.” - Dr. Tyler Sugerman
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Read The Transcript:
Dr. Sugerman: [00:00:00] So if you've ever been out for a stroll with your dog and suddenly you see them drink a mystery greenish liquid from off the ground, or maybe your cat suddenly comes home and seems a little drunk. That mystery liquid could be something very deadly. So listen in as we discuss ethylene glycol toxicity and how alcohol can actually save lives.
Hi, and welcome to Vetsplanation. I'm your veterinary host, Dr. Sugerman, and I'm going to teach you about veterinary medicine. In this podcast, we can dive deeper into the understanding of what our pets are going through and break down medical terms into easier to understand chunks of information. Just a quick disclaimer, this podcast is for informational purposes only.
This is not meant to be a diagnosis for your pet. If you have questions about diagnostics or treatment options, please talk to your veterinarian about those things. Remember, we are all practicing veterinary medicine and medicine is not an exact science. Your veterinarian may have different treatment options and different opinions.[00:01:00]
The information I provide here is to help pet parents have a better understanding about their pets. If you like our podcast, please consider sharing this podcast with at least one friend or just somebody else who has pets as well. Now, let's jump into this week's episode.
All right, welcome back to Vetsplanation, everyone. I am your host, Dr. Sugerman. And thank you for joining in to learn more about the scary side of our winter in veterinary medicine. Let's dive in and talk about this weird word, ethylene glycol.
So what is it actually? We don't see it as much now as we did 20 years ago, but ethylene glycol is antifreeze. And it's used most commonly in like vehicle radiators during the winter to help regulate the engine's temperature and also in things like hydraulic brake fluid. It's found in a variety of other things as well, some household products, such as those ink pads that you use for stamps or de-icing products.
It's even in ballpoint pens, paint, plastic, films, [00:02:00] and some cosmetics as well. Usually though those are pretty small amounts of them. We're more worried about things like the radiator fluid.
One of the main components of antifreeze is this mixture of ethylene glycol. Sometimes it's a 50 50 mixture with water. But even worse, it comes also in a 95 percent ethylene glycol, which is why this becomes so toxic to our pets. So you would think that pets wouldn't want to drink a chemical, right? But the problem is, is that actually had a very sweet taste to it and it's odorless and technically colorless.
But companies put green or yellowish green liquid or coloring into it to make it look like a color. I did say though that we do not see this toxicity as much. And that's because in 2012 manufacturers started putting in a bittering agent to help deter animals from drinking it.
Some animals don't care though. They don't care if it's bitter. I've had lots of [00:03:00] sick pets that were licking bitter apple, or I've put alcohol on their band aid to make sure they don't eat it. And they don't care. I could put a bitter apple on my finger and some of them will just lick it right off.
They, they don't care though. They'll still, they still love that bitter taste. So unfortunately, we still have too many animals that get into ethylene glycol. So let's talk about how they're exposed next. First of all, any animal can get ethylene glycol toxicity. But dogs and cats are especially vulnerable since they're in the garage more where people are working on their cars or cats are staying underneath cars to keep warm.
And this usually happens during the colder months in cold climates and in the spring when cooling systems are being flushed. Usually the fluid leaks out of the vehicle, and it's either discarded improperly, or they just leave it on the ground. The cat or the dog will most likely drink the fluid, but cats can get a toxicity just through what we call transdermal contact, meaning they could literally just walk through it [00:04:00] and that fluid will absorb into their skin or on their paws. So how much fluid do you think would need to cause a toxicity?
So in a cat, they only need 1.4 mils per kg of the 95 percent antifreeze. So if we said that we had like a 10 pound cat, that would be of that kind of do a 50 50 mixture. They would need to drink about 12 mils. Or if it got into the 95 percent mixture, it would need to drink about 6 mils.
That's a really tiny amount. So for those of you who have kids and remember having those cups that you use for like Motrin, the liquid Motrin and liquid Tylenol, right? Most older kids need to drink 10 mils of medication. That is not a lot. If you're an adult without kids, then imagine an average shot glass.
That would be about a fourth of a shot glass for the 50 50 mixture, and it would be about an eighth of a shot glass for that 95 [00:05:00] percent mixture. So a cat could easily drink that in just a couple of seconds. For a dog, luckily they're not as sensitive to this, but they still have big tongues so they can lap up quite a bit more than a cat in a shorter amount of time.
So the lethal dose for a dog is about 4.4 milligrams per kilogram. So basically what that means is for about a 10 pound dog, this would be equivalent to 20 mils of the 95% mixture or two of those medicine cups, or a little less than half a shot essentially.
For a 50 50 mixture, that would be about 40 mils or four medicine cups or essentially one shot. So how about an average of a 60 pound dog? They would have to drink more for sure. They would need to have about 120 mils of the 95 percent ethylene glycol, which is about three shot glasses or four ounces.
So think of half of a kid's size, hot chocolate cup from Starbucks. For the 50 50 mixture, [00:06:00] that would be about 240 mils, or six shot glasses, or a whole kid's hot chocolate from Starbucks for a 60 pound dog. So that's still not that much, right? They could definitely still drink that in a short amount of time.
Okay, I know we don't normally talk about guinea pigs, but they still fascinate me. I just love them. Remember when I said that they could eat really large amounts of rodenticide and not be affected?
Their toxic dose of ethylene glycol is 6.6 mL per kg. The average guinea pig weighs about 2 pounds. So an average adult guinea pig would need to drink about 6 mL of that 95 percent or 12 mils of the 50 50 dilution. That's how much I told you that the 10 pound cat would need to drink for it to be lethal.
They could drink so much ethylene glycol. I don't want them to drink ethylene glycol. We don't want to give it to them. But I'm just saying that's pretty crazy that they could drink that amount. Like the same amount as a 10 pound cat. All right. These are [00:07:00] all lethal doses, by the way. We aren't even talking about the doses that are needed just to cause symptoms, but not death.
Sorry, I know that there's a lot of math but it was just to give you an idea of the fact that they really don't have to drink very much in order to cause a toxicity. And I'm done with the math now, don't worry. So ethylene glycol, it is really rapidly absorbed from the GI system, meaning from like the stomach and the intestines, it reaches like the peak amount that it can absorb in about one to four hours, which is such a tiny, tiny amount of time.
So let's talk about what occurs in the body when they do ingest it. So in general, the first organs that are affected are the kidneys and the blood. So it causes damage to the kidneys and it causes the blood to become very acidic or more like acid. I won't go into all the biochemistry too much of what happens, but in general, like ethylene glycol is broken down into two things that are going to attack the kidneys and cause that blood to become more acidic.[00:08:00]
So it's not necessarily the ethylene glycol itself that is toxic, it's actually the things that it's broken down into. And that's important when we think about how we're going to treat this. So let's first talk about like our symptoms. Symptoms, they depend on how much toxin has been broken down. Not how much toxin has been absorbed, but how much toxin has been broken down.
So between 30 minutes to 12 hours, The symptoms are very interesting. Usually, the pet acts as if they're drunk. They mimic as if they had gotten into ethanol, or if they had gotten into some sort of alcohol toxicity. They usually will have vomiting, they'll drink a lot of water, possibly urinate a lot as well, they'll be depressed, and just really wobbly while they're walking.
And then suddenly they recover. So it seems like they're fine, and it's not a huge problem. So most people are like, Oh, I've just gotten into a little bit of alcohol from somewhere. No big deal. Cat's doing better already. If we don't bring them in during that period of time that can be pretty bad.
Because [00:09:00] after that, the chemical is being broken down and affecting other organs. So in cats at about 12 to 24 hours, so half a day to a day, and for dogs, 36 to 72 hours, so a day and a half to three days, they go into kidney failure. Like for cats, they could drink the ethylene glycol and half a day later, end up in kidney failure.
That's pretty fast. They're unable to urinate because their kidneys are no longer working. Their belly or their abdomen feels very painful because their kidneys are really painful and they accumulate all this fluid in their abdomen because their fluid has nowhere else to go.
They aren't eating, they're vomiting, possibly having diarrhea. The heart rate and breathing are very high, and eventually it leads to seizures and death. All of this, in just half a day to three days after drinking it. So it's pretty deadly and pretty sad, unfortunately. Now, how do we diagnose this since all this happens so quickly?
Ideally, it's great [00:10:00] if the pet parent knows that the pet had gotten into ethylene glycol, but that's not always the case. In most of our situations, so we usually have to go off of like what the clinical science that the pet parent sees at home, as well as our diagnostics.
So people often miss that drunk part, whether it's because that pet was outside during that period of time, or they were at work and just came home to see vomit all over the house. There are many different things that cause vomiting that, like we've discussed before, therefore we usually have to start doing blood work and x rays or radiographs.
Depending on the age of the pet, if we don't know anything about the ethylene glycol exposure, we need to start running those diagnostics to try to start ruling out some other things that could potentially be happening. We'll talk about the blood work first, then depending on how long ago they got into ethylene glycol, the kidney values may be normal.
If it was pretty quickly that you brought them in, or they could be elevated depending on the timing, if it's a couple of hours. Or it could be sky high if it was [00:11:00] by the next day, within 24 hours. When they're very high, that makes us question a lot of different toxins and other reasons for kidney failure, especially like in our younger pets, not all hospitals are going to have the ability to run this.
But we do look at blood gases. It basically tells us whether the blood is acidic because that will occur within about three hours of ingesting the toxin. Again, not a slam dunk for this is ethylene glycol toxicity, but with the elevated kidney values and the acidic blood, that makes it higher on our list of possibilities or what we call differentials.
One thing that is usually performed at the same time as blood work is a urinalysis. So basically taking urine and looking to see what it looks like. In the urine, there's these crystals, they're called calcium oxalate crystals. That can be present in that urine if we see that now, we're even more worried about ethylene glycol.
That just really bumps it to the top of our [00:12:00] list at that point. At this point the hospital doesn't have a way to be able to confirm ethylene glycol. That's usually when they're just start treating for it, but there are a confirmatory test for this. This 1 is 1 of the very few, the ones that we have to confirm a toxin. So it's a test that can be used, but it can only be used during very specific time periods.
It can be used between 1 hour and 10 hours after ingestion. And then it can be used at 24 to 36 hours after ingestion. It looks for oxalate in the bloodstream, which is one of those crystals or one of the components of crystals. And it also looks for the other components that ethylene glycol is broken down into
now, if there's a suspicion that they got into it, then we cannot confirm it or if there is this weird 11 to 24 hour window then again, we can't confirm that. Now there's like a suspicion that your cat got into it and it's only been within the first 30 minutes. We're [00:13:00] not going to be able to confirm that at that point, or if we're at this weird 11 to 24 hour window that again, that test is going to come up negative because all those things have not been broken down into the correct elements yet.
Now this could be really bad, because think about cats, they could die within 24 hours, right? So if we can't confirm it, it makes this very difficult to know whether we need to treat it or not. So if we have any suspicion at all, we're just going to treat them rather than risking them dying, unfortunately.
So let's talk about our treatment. At this point, they have to be hospitalized. Unfortunately, there is no way around this one. There is no at home treatment for this. You've heard me talk many times before about making your pet vomit as much as possible. But the problem is, if they're showing any neurological signs at all, we cannot make them vomit.
Also, this is a liquid, and I told you that it absorbs very quickly, within one to four hours. So most likely, a lot of that has already been absorbed, even by the time you get them to us. If [00:14:00] we make them vomit... During a period of time when they are very neurologic, we can actually cause a much bigger problem.
We could have them get an aspiration pneumonia, which is where they vomit and then inhale it. And that goes back into their lungs. And that would have multiple problems. We'd have to deal with both the ethylene glycol toxicity and the aspiration pneumonia. And this toxin, like I said, is absorbed so quickly, therefore making them vomit is usually not as beneficial.
So basically, if you see them get into it, you just basically need to get them into the hospital immediately. Ideally, a big hospital or a hospital that carries fomepizole, it's also known as four mp. I suggest that whatever you call for vet hospitals, or if you go to a vet hospital, normally that you should ask them if they have the capability of treating ethylene glycol toxicity, you want to know that immediately, rather than having to like, drive around from hospital to hospital or calling around from hospital to hospital to just be able to do that ahead of time and know where [00:15:00] you could go.
If there's a chance that they can even get exposed to this, even call ER clinics ahead of time and just ask them. Hey, are you able to treat an antifreeze toxicity? Most of them will be able to tell you yes or no, whether they think that that is something that they can do or not. Like I said, they will have to be hospitalized, which means 24 hour care.
So usually just regular general practices are not going to be able to do that. Typically, ERs or specialty clinics are the ones that have to do that. So they'd have an IV catheter placed. And then they would have IV fluids that they're given or basically fluids that are going directly into the bloodstream.
The goal here is to try to help with dehydration. We're trying to help correct that. And then we're also trying to help fix their blood being acidic. And we also have to try to flush out as much of that toxin as possible before it can break down and create more problems. Next, we try to give something to block ethylene glycol from being broken [00:16:00] down by that toxic substance.
This isn't necessarily an antidote, but it does help stop that breakdown, so it helps stop that from forming in the first place. There are two drugs that are used. The first one, like I said, is one that you should ask if the hospital has. It's called fomepizole, or a four... MP, um, and it helps stop the ethylene glycol from breaking down into those toxic components.
The nice thing about this drug is that it doesn't have very many side effects, but they do need to be on that medication for about 36 hours. The other caveat is that it needs to be given within the first like 8 to 12 hours after ingestion for dogs, and within the first 3 hours for cats, otherwise they're not going to survive.
Now, fomepizole is really expensive and not everybody carries it. Therefore, kind of our, our alternative is ethanol. And the people who, those who don't know what ethanol is, it's alcohol. If you've ever joked wanting to have an IV bag of [00:17:00] alcohol this is literally what we are doing. It acts the same way to help stop that ethylene glycol from being broken down, but it has a lot more side effects.
So remember one of the clinical signs I told you is that they act drunk. Alcohol is going to make them do that when we give it to them in their veins. They're going to act drunk, which makes this very difficult to go off of just their clinical signs to know if they're worse, or if they're getting better, or if this is just the alcohol.
Instead, we have to monitor their blood work and whether they're urinating to determine if they're getting worse or if they're improving. I will mention one other treatment that's not as common, but you can perform dialysis on pets. It's not something that most veterinary hospitals have the capability of doing, and they often have to find a place like a teaching hospital or a really large specialty hospital that's going to be able to do that.
Another common thing though is that we also have to be checking their blood sugar, like we got to make sure they're maintaining their blood sugar. Hypoglycemia means [00:18:00] low blood sugar. That occurs with these pets, and we have to make sure we can supplement those things as well for them. So there's a lot of things we have to monitor and balance.
And even with doing everything we do, this is still a really guarded to grave prognosis, meaning that they do not have a great chance of pulling through this. A big prognostic indicator, or basically like a big red flag for us, is that if the pet is urinating only small amounts, or not producing any urine at all, this means that that toxin has already affected the kidneys too much and they have shut down.
The earlier we catch this and get treatment into them, the better of a chance that they have. I'm just going to go over some commonly asked questions about this. So one of the commonly asked questions is, why am I not using charcoal for this toxicity? Any toxin that ends in ol so O L, it doesn't bind to charcoal and therefore it's not going to work.
So therefore we'd be putting the pet more at risk of aspiration pneumonia by trying to [00:19:00] give them the charcoal by mouth. Another common question is, can I just give my cat or dog alcohol by mouth at home instead of hospitalizing them? And no, unfortunately they cannot absorb the alcohol quick enough and generally that pet vomits it up anyways or they get aspiration pneumonia because you're trying to give it while they're neurologic.
It needs to go into the vein and into the bloodstream in order to make this effective. Some people have also asked me like if there's a pet safe antifreeze. And first of all, I am not an auto mechanic, but I have found that you can use products that have propylene glycol, which is much safer if ingested than the ethylene glycol.
Alright, that's it to talk about our ethylene glycol toxicity. That's a really sad toxicity, unfortunately but we are going to talk about a fun animal fact today, end on a happy note, right? So today we're going to be talking about the Mata mata turtle. If you don't know what I'm talking about, then you should definitely look them up. Their heads look like a leaf. So it looks like a [00:20:00] leaf that has fallen to the bottom of the water.
It's head is very flat, and has a very wide mouth with kind of a long snorkel for a snout. Oh, and its head is also covered with these like wart like projections on it. They live in this really soft, muddy bottoms of slow moving bodies of water, like marshes and things like that. So now combining their snorkel like nose and this really shallow body of water, they only have to make small movements and they can just stick their little snorkel like snout out of the water to be able to breathe while waiting for some unsuspecting fish to pass it. And you would think that with their heads up in the water, like it would be really difficult for them to see a fish, right? Actually they have terrible eyesight, so that doesn't really matter anyways.
So besides the other weird things with their head, they also have the skin flaps on the side of their neck that helps them feel vibrations of the nearby prey. They also have really excellent hearing for prey as well. And when they do [00:21:00] feel prey nearby. They, they make this vacuuming suction and then actually they like vacuum up the little fish.
They also have little webbed toes. And so you would think that if it being a turtle in the water, webbed toes, like this all sounds like they're very built and capable of swimming, but they're actually terrible swimmers. The juveniles, they swim awkwardly, but the adults don't even leave the muddy, shallow bottoms.
They just stay down there. Now these guys are mostly found throughout like the Amazon of South America, but they can also be found on the island of Trinidad. When they lay their eggs, they'll usually lay them in a vegetation near the edge of the forest. So their incubation period is like a whopping 200 days.
That's, that is crazy. And here's why I picked them. So the other crazy thing about these guys is they are actually nocturnal. There's not a lot of nocturnal turtles, and and a good majority of those nocturnal turtles do have some pretty unique looks [00:22:00] to them. You should look them up. But us night owls have to stick together, so I thought the Mata mata turtle was a, was a good one.
Alright, as always, if you have any questions, comments, or suggestions, please email us at Suggs@vetsplanationpodcast.Com, or you can find us on social media. I'm usually on Facebook the most. Also, if you want to donate to help keep our production going, we'll link that in the show notes. And next week we'll be talking about swimmer's tail, right?
Thank you to everybody and please always make sure to keep your pets happy, healthy, and safe. Thanks.
Thank you guys for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, you can email me at Suggs, S U G G S @ VetsplanationPodcast.com or visit the website at VetsplanationPodcast.com or find us on Facebook, Instagram, or TikTok at Vetsplanation. Thank you all for listening and I'll see you back here next week.[00:23:00]