Journal article
Propylene glycol toxicity from compulsive corn starch ingestion
The American journal of emergency medicine, Vol.53, pp.286.e1-286.e3
03/2022
DOI: 10.1016/j.ajem.2021.09.054
PMID: 34602331
Abstract
Propylene glycol (PG) is usually considered safe, however, toxicity can develop with high doses or when used for prolonged periods of time. PG can be found in some medications as well as some food products. We report a case of likely PG toxicity that occurred after compulsive daily ingestion of large amounts of corn starch.
Our patient initially presented to an outside hospital (OSH) via ambulance for altered mental status. Her mental status improved after her blood sugar of 25 was corrected. On admission to OSH Emergency Department her initial vital signs included a heart rate of 115 bpm, blood pressure 113/59 mm/hg, temperature 35.8C. Pertinent labs included: sodium 119 mEq/L, bicarbonate 9 mEq/L, anion gap 29 mEq/L, creatinine 2.5 mg/dL and lactic acid 20 mEq/L. On transfer to our hospital her repeat lactic acid was 20 mEq/L, osmolar gap was 20. Her PG level, which was drawn several hours after her initial presentation, was 11 mg/dL. Our patient noted that she ingested a 16 oz. package of corn starch mixed with baking soda approximately every 2 days. Given the concerns for PG she was underwent intermittent hemodialysis. PG and lactic acid levels improved, however, she ultimately died due to complications from her hospitalization.
PG causes toxicity through metabolism to lactic acid. While there are small amounts in food products and medications, under the right circumstances, PG can accumulate and lead to significant toxicity.
•Propylene glycol is an additive found in many medications and foods•Propylene glycol is converted to lactic acid via alcohol dehydrogenase and subsequently aldehyde dehydrogenase•High propylene glycol levels can lead to elevations in lactic acid along with anelevated anion gap metabolic acidosis•Diagnosis is often based on history as well as the presence of high osmolar and anion gaps•Treatment involves discontinuation of the propylene glycol-containing xenobiotic and hemodialysis for severe toxicity
Details
- Title: Subtitle
- Propylene glycol toxicity from compulsive corn starch ingestion
- Creators
- J. Peterson - Wake Forest UniversityR. Stadlen - University of Iowa Hospitals and ClinicsJ. Radke - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.53, pp.286.e1-286.e3
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.ajem.2021.09.054
- PMID
- 34602331
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Language
- English
- Date published
- 03/2022
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984296981502771
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