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Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection

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Abstract

Introduction

Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG.

Methods

This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay.

Results

Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were “positive.” At the manufacturer’s threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7–100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of −5.3 (−8.9 to −1.7).

Conclusions

The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.

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Acknowledgements

We thank David Templeton, MS, and Catachem Inc. for in-kind support in providing reagents.

Funding

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Authors and Affiliations

  1. Arkansas Poison and Drug Information Center, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA

    Ari B. Filip

  2. Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA

    Christopher W. Farnsworth & Bridgit O. Crews

  3. Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Michael E. Mullins

  4. Medical and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA; UCLA Membrane Biology Laboratory, Division of Nephrology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Jeffrey A. Kraut

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Correspondence to Ari B. Filip.

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Conflict of Interest

David Templeton, MS, and Catachem Inc. (Oxford, CT) provided the glycerol dehydrogenase reagents. Neither Mr. Templeton nor any other agents or employees of Catachem Inc. had any role in the study design or the data analysis.

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Data in this study were previously presented at North American Congress of Clinical Toxicology (NACCT), San Francisco, CA, 2022.

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Filip, A.B., Farnsworth, C.W., Mullins, M.E. et al. Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection. J. Med. Toxicol. 19, 362–367 (2023). https://doi.org/10.1007/s13181-023-00967-x

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