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Original Investigation |

Long-term Renal and Neurologic Outcomes Among Survivors of Diethylene Glycol Poisoning

Laura Conklin, MD1; James J. Sejvar, MD2; Stephanie Kieszak, MA, MPH1; Raquel Sabogal, MPH1; Carlos Sanchez, MD1; Dana Flanders, MD, PhD1; Felicia Tulloch, PhD3; Gerardo Victoria, MD3; Giselle Rodriguez, MD4; Nestor Sosa, MD5; Michael A. McGeehin, PhD1; Joshua G. Schier, MD, MPH1,6
[+] Author Affiliations
1Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
2Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
3Hospital Santo Tomás, Panama City, Panama
4Caja de Seguro Social, Panama City, Panama
5The Gorgas Memorial Institute, Panama City, Panama
6Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
JAMA Intern Med. 2014;174(6):912-917. doi:10.1001/jamainternmed.2014.344.
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Importance  At least 13 medication-associated diethylene glycol (DEG) mass poisonings have occurred since 1937. To our knowledge, this is the first longitudinal study characterizing long-term health outcomes among survivors beyond the acute poisoning period.

Objective  To characterize renal and neurologic outcomes among survivors of a 2006 DEG mass-poisoning event in Panama for 2 years after exposure.

Design, Setting, and Participants  This prospective longitudinal study used descriptive statistics and mixed-effects repeated-measures analysis to evaluate DEG-poisoned survivors at 4 consecutive 6-month intervals (0, 6, 12, and 18 months). Case patients included outbreak survivors with a history of (1) ingestion of DEG-contaminated medication, (2) hospitalization for DEG poisoning, and (3) an unexplained serum creatinine level of 1.5 mg/dL or higher (to convert to micromoles per liter, multiply by 88.4) during acute illness or unexplained exacerbation of preexisting end-stage renal disease.

Main Outcomes and Measures  Demographics, mortality, dialysis dependence, renal function, neurologic signs and symptoms, and nerve conduction studies.

Results  Of the 32 patients enrolled, 5 (15.6%) died and 1 was lost to follow-up, leaving 26 patients at 18 months. Three (9.4%) missed 1 or more evaluations. The median age was 62 years (range, 15-88 years), and 59.4% were female. Three (9.4%) patients had preexisting renal failure. Enrollment evaluations occurred at a median of 108 days (range, 65-154 days) after acute illness. The median serum creatinine level for the 22 patients who were not dialysis dependent at time 0 was 5.9 mg/dL (range, 1.8-17.1 mg/dL) during acute illness and 1.8 mg/dL (range, 0.9-5.9 mg/dL) at time 0. Among non–dialysis-dependent patients, there were no significant differences in the log of serum creatinine or estimated glomerular filtration rate over time. The number of patients with subjective generalized weakness declined significantly over time (P < .001). A similar finding was observed for any sensory loss (P = .05). The most common deficits at enrollment were bilateral lower extremity numbness in 13 patients (40.6%) and peripheral facial nerve motor deficits in 7 (21.9%). All patients with neurologic deficits at enrollment demonstrated improvement in motor function over time. Among 28 patients (90.3%) with abnormal nerve conduction study findings at enrollment, 10 (35.7%) had motor axonal involvement, the most common primary abnormality.

Conclusions and Relevance  Neurologic findings of survivors tended to improve over time. Renal function generally improved among non–dialysis-dependent patients between acute illness and the first evaluation with little variability thereafter. No evidence of delayed-onset neurologic or renal disease was observed.

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Figure.
Trends in Serum Creatinine Measurements Among 16 Survivors of a Diethylene Glycol Mass-Poisoning Event During Acute Illness (July-October 2006) and at 4 Serial Follow-up Evaluations (January 2007–July 2008)

Participants who died (n = 5), were dialysis dependent at more than 1 evaluation (n = 10), or were lost to follow-up (n = 1) on or before July 2008 are excluded. Colored lines indicate serum creatinine levels of individual patients observed over time. SI conversion factor: To convert serum creatinine to micromoles per liter, multiply by 88.4.

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