A Fatal Case Involving Extremely High Levels of Ethylene Glycol Without Elevation of its Metabolites or Crystalluria

A unique case of an intentional overdose of ethylene glycol resulting in a fatality is described. The decedent had a very high concentration of ethylene glycol without elevated concentrations of its metabolites or crystalluria. The ethylene glycol concentrations in blood, urine, and vitreous fluid were 2340, 2261, and 1028 mg/dL, respectively. Osmolality of blood and vitreous fluid was also very high at 1426 and 534 mOsm/kg, respectively. No crystals were found in the urine. Furthermore, on the urine organic acids profile the ethylene glycol metabolites oxalic, glycolic, and glyoxylic acids were within the reference ranges. In addition to ethylene glycol, the decedent had an elevated level of mirtazapine, an antidepressant, and a low level of bupropion. It was estimated that the subject consumed 1034 g of ethylene glycol. To our knowledge, this is the first case of death from severe ethylene glycol poisoning in the absence of ethylene glycol metabolites or crystalluria.