Antifreeze (ethylene glycol) intoxications in Baltimore. Report of six cases.

Records of the Office of the Chief Medical Examiner (OCME) for the State of Maryland were reviewed for all deaths related to acute ingestion of antifreeze (ethylene glycol [EG]) occurring between December 1985 and December 1987. Six cases were identified. In three cases, the manner of death was classified as undetermined, in two suicide, and in one case the intoxication was considered to have contributed to death, but was not the main cause. Clinically, the hospitalized subjects exhibited primary metabolic acidosis with hypocalcemia, hyperglycemia, and an elevated anion and osmolar gap. At autopsy, the findings related to EG ingestion were typical of a non-specific drug intoxication. Histological examinations in five cases demonstrated the presence of calcium oxalate crystals in the renal tubules; in three cases extensive renal tubular necrosis appeared related to the survival time. The toxicological analysis in three cases revealed lethal EG levels in the blood.