Antifreeze Poisoning In Dogs And Cats
And Other Products That Contain Ethylene or Diethylene Glycol
After the first few days, the damage, signs and treatment of ethylene glycol/antifreeze poisoning are much the same as those for kidney failure. You can read about them here
To read about all the toxic substances pets in America eat accidentally, go here
Ron Hines DVM PhD
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As of December, 2012, it is illegal to sell non-bittered antifreeze in the USA. That does not mean that all non-bittered antifreeze is off the shelves. Bittering agents of the kind used in sprays to discourage pet licking, are quite ineffective. So remain cautious with your pets.
Over the years, EG and rodent baits have accounted for about equal numbers of cases; but while most pets that eat rat or mouse poison survive, most that consume ethylene glycol products do not. That is because the symptoms of rodent bait consumption are quite distinctive and veterinarians have very effective antidotes for these (Warfarin-like) products that can be given any time after the bait was consumed.
But the early signs of ethylene glycol poisoning are vague and non-specific. So it is very hard for veterinarians to reach the diagnosis within the 3-8 hour window when antidotes will help your pet most. After that, when a substantial amount of ethylene glycol was consumed, irreversible damage to your pet’s kidneys has most likely occurred.
There are many chemicals in the group called alcohols. Some can be safely consumed and some can not. Ethylene glycol is also an alcohol. Unlike ethanol (grain alcohol), EG breaks down in the body to form very toxic by-products. Because it doesn’t boil off at car radiator temperatures, it makes an ideal radiator antifreeze. It is sometimes also a constituent of brake and hydraulic fluids.
Ethylene glycol is an ingredient in certain liquid rust inhibitors. It is incorporated in solar collectors and used in many chemical manufacturing processes. I have read that it is, or was, an ingredient in the liquid placed inside of decorative “snow scene” glass globes. You can read more about the places that use it and products that might contain ethylene glycol in Wikipedia.
Despite its wide use in a multitude of products, the most common source to pets is car antifreeze. Antifreeze poisoning occurs even in warm climates because radiator coolant in all climates contains ethylene glycol to inhibit rust and motor corrosion.
Diethylene glycol (DEG)is another chemical that is potentially toxic to your pet’s kidneys. Diethylene glycol is a compound that consists of two joined ethylene glycol molecules. It is also widely used in the manufacture of plastics and printing ink, solvents and resins. It would be most likely to be found in your home in household cleaners.
Although both EG and DEG cause kidney damage, the method by which DEG does so is less well understood but doesn't appear to the same as that of ethylene glycol (oxalate crystals do not form in the kidneys) There have been reported cases of poisoning in dogs due to the ingestion of this compound. (ref)
Why Is Ethylene Glycol / Antifreeze So Poisonous to Pets and Humans ?
Ethylene glycol is a syrupy liquid with no color, no odor and a taste that is described as somewhat sweet. The poisonous nature of these compounds was not discovered until the 1930s. (Massengill incident)
Ethylene glycol kills in an indirect way. It, in itself, is not poisonous – initially your pet will just act tipsy like it would if it consumed bourbon whiskey. But a particular liver enzyme, alcohol dehydrogenase begins a process that leads to a very dangerous by-product , glycolic acid. which is, itself, transformed into oxalic acid. Oxalic acid combines with the calcium in your pet’s blood to form calcium oxalate which blocks and destroys critical parts of your pet’s kidneys, its nephrons. through mechanical blockage and increased back pressure .
The breakdown products of ethylene glycol are all acidic. It is this abnormal blood acidity that is responsible for many of the early signs of ethylene glycol poisoning. If the pet survives these initial symptoms – and most do – it is the formation of calcium oxalate in its kidneys that is its chief danger. (The inability of calcium oxalate, once formed, to dissolve; leads to other problems in pets that have not drunk antifreeze, calcium oxalate kidney stones, which you can read about here.)
Although ethylene glycol is toxic to all animals, it may not affect them all equally because the liver alcohol dehydrogenases of different species apparently differ in their ability to begin this toxic process. (ref)
How Common Is Antifreeze Poisoning In Dogs And Cats ?
That question is difficult to answer. That is because veterinarians suspect that the majority of cases in pets probably go unreported. Older pets that develop kidney failure are often assumed to have died of some other disease. Only on rare occasions are the kidneys of deceased pets that diet unexpectedly, examined by pathologists for tell-tale oxalate crystals. In human beings, there were 5815 human cases reported in the United States in 2002. But in humans, antifreeze is most commonly provided or intentionally consumed. (ref) One might conclude that unknowing, unsupervised pets are at considerably greater risk.
Between 1979 and 1986, 104 dogs and cats were brought to the Veterinary Teaching Hospital at Colorado State University for poisoning. Of those, 30 had consumed ethylene glycol and 53 had eaten rat poison. Although ethylene glycol poisoning was not the most common problem, it was the most common cause of poisoning death. You can read that study here.
There is probably also a large group of pets that consume antifreeze, but not in quantities sufficient to become suddenly ill. Those pets can go on to develop kidney failure much later. You can read about one case like that here.
Do Dogs And Cats Actually Seek Out And Consume Antifreeze Because Of Its Pleasant Taste ?
That is unclear and possibly untrue. Although that statement often appears on the internet in articles about antifreeze poisoning in dogs and cats, I only know of two studies in which dogs were offered their choice of antifreeze or water.
In the first study, the animal’s choice was antifreeze, straight ethylene glycol, water or sugar water. In that study, the majority of pets were very reluctant (91% of them) to drink antifreeze when ordinary tap water was available to them. That study was not very scientific and no mention is made whether the antifreeze used might have contained bittering agents (Denatonium Benzoate) that were in occasional use at the time. You can read the first study here.
In the second study, neither dogs nor rats ever preferred antifreeze to water. You can read that study here.
Have You Personally Dealt With This Problem ?
I saw my first case of antifreeze poisoning soon after completing veterinary school. Its was a little dog that just didn’t seem right to its owners. When I examined the pet, the only thing I could find that was wrong was some tummy sensitivity in the area of its kidneys and an empty stomach. Unfortunately, the lab work showed that irreversible damage to the pet’s kidneys had already occurred. That dog did not survive.
My second case of antifreeze poisons was much luckier. This was a 9 week old Christmas-gift Labrador puppy that was seen drinking antifreeze that very Christmas day. I sent one of my staff to the neighborhood liquor store and had them purchased a fifth of vodka. I added some of that and bicarbonate to oral and subcutaneous fluids and kept the puppy drunk for 72 hours. He recovered completely.
That grain alcohol is an antidote to ethylene glycol was discovered by a perceptive physician many years ago. That physician, working in Boston, treated sixteen teenagers who had mistaken antifreeze for liquor while partying. He noticed that the ones who were the drunkest were the ones who survived. I believe that is the same incident that you can read about here.
What Are the Symptoms Of Antifreeze / Ethylene Glycol Poisoning In Pets ?
The first signs that a pet has consumed a substantial amount of ethylene glycol are the same as they would be if the pet had drunk an equivalent amount of grain alcohol in liquor. However, since something like bourbon whiskey is only 40-80% ethanol alcohol and antifreeze is 80-95% ethylene glycol, it will not take as much of the later. So the pet might act ‘tipsy” (inebriated) or it might just become inactive.
It takes about 3 hours for EG to be fully absorbed from the pets
In the second phase of this problem, the breakdown products of EG (glycolic acid, formic acid, oxalic acid, lactic acid) begin to acidify the pet’s blood too much. This causes problems in respiration, heart rate and nerve function - any bodily process that is affected by acid-base (pH balance).
These first two phases are often missed by pet owners or attributed to other things by veterinarians because they are so non-specific and variable. Perhaps you would think that your pet was “just having a bad day”. Veterinarians see hundreds of pets with similar non-specific signs every week and over 99% of them have not consumed ethylene glycol.
Very few pets will consume enough ethylene glycol to die during the first two stages. It is the third stage that is the most dangerous and unexpected to owners because it occurs without visible symptoms of distress. The glycolic acid liberated from ethylene glycol is, in itself, probably damaging to its body (directly toxic). But as your pet metabolizes ethylene glycol, this glycolic acid is further broken down into excessive amounts of oxalic acid. That oxalic acid has an affinity for (binds to) the calcium in your pet’s blood. The two combine to form excessive amounts of calcium oxalate crystals. Calcium oxalate is insoluble at body acidity – so it forms plugs that block and shut down the tiny tubes that form your pet’s kidney apparatus. Without the ability to cleanse its body of waste products, blood levels these wastes that include blood urea nitrogen (BUN) and creatinine rise to toxic levels. That is the point that you would notice something was very wrong. The pet becomes depressed. It ceases eating. It begins to vomit. It may walk with its belly tucked up and show pain in the area of its kidneys. Its urine volume, frequency and color may change (dark or pink = hematuria).
The pet will show all the symptoms of renal (kidney) failure; which,
indeed, it now has. It has become uremic. You can read more about
the symptoms of uremia in pets here.
How Much Antifreeze Does My Pet Have To Drink To Become Sick ?
That depends on a number of factors:
Most automobiles run a mixture of 50% antifreeze and 50% water. With time, it is the water that will evaporate and additional pure antifreeze is often poured in. (although the correct way is to use a hydrometer/refractometer). It is the total amount of ethylene glycol consumed, not the volume of liquid, that is important.
Before the pet's body breaks EG down into toxic products, ethylene glycol is excreted, unchanged in the urine. So the hydration, water consumption and rate of urination of your pet will effect the severity of symptoms and damage. The more that is eliminated unchanged (peed out) , the better.
A dog must consume about one-half to one teaspoons of pure ethylene glycol per pound of body weight to be lethal. (4.4-6.6ml/Kg). It is about three times more toxic to cats and humans (1.4-1.5ml/kg) ref1 ref2 However, if the pet receives either ethanol or fomepizole treatment in time, it can survive a much larger dose.
What If My Pet Gets Ethylene Glycol Products On Its Hair or Skin ?
What would be of concern would be a pet licking off a cumulatively toxic dose while grooming. So any pet that routinely frequents contaminated garages, mechanic shops or junk yards could face this hazard. Unfortunate dogs that are kept in these locations for security purposes do not lead long lives. Perhaps ethylene glycol exposure is one factor involved in that.
How Will My Veterinarian Diagnosis Antifreeze Poisoning ?
It is not that likely that your veterinarian will suspect antifreeze exposure in your pet unless you bring that possibility to his/her attention or the pet's history suggests it.
If you are very fortunate, the veterinarian might notice that your pet exhibits pain when the area around its kidneys is pressed. Your veterinarian might also note characteristic ,six-sided or Maltese-cross shaped crystals of calcium oxalate crystals in your pet’s urine – although a few crystals often occur in normal, acidic, urine.
If you mention that your pet has begun vomiting, that + the kidney pain might be another clue. If your veterinarian performs an ultrasound examination of your pet’s abdomen, the vet might notice that the pet’s kidneys reflect the ultrasound waves more than they should (increased echogenicity) (Although many other things can cause that) .
If your vet were to pass the ultraviolet lamp used to diagnose ringworm over the pet’s urine, the vet might notice that it glows (fluorescence). (ref)
But the most important clues of early ethylene glycol poisoning are to be found in your pet’s blood work. They are an increased anion gap and osmolar gap , signs that your pet’s blood has become more acidic (metabolic acidosis), and that some compound is present in its blood that shouldn’t be. Lowered blood calcium levels (hypocalcemia do to its binding to oxalate) is also a common finding. The pet’s blood pH will also be lower than normal. You can read more about that here.
There are commercial test kits that detect ethylene glycol in the blood of pets. They are most accurate for 1-6 hours after the compound is ingested and probably not of value if over 12 hours have passed. The test kit may not be sensitive enough to detect doses of EG that can be toxic to cats and certain medications given in suspected poisonings can cause a false positive (certain charcoal antidotes, Valium and barbiturate solutions and other preparations that might contain propylene glycol ). The test kits are not on hand at many local veterinary clinics - check with veterinary emergency centers in your area.
What Treatment Does My Pet Need If It Drank Antifreeze ?
Because ethylene glycol is absorbed into the body so quickly, oral medications designed to make a pet vomit up toxic materials (things like hydrogen peroxide solutions) or rinse out its stomach (gastric lavage) are only helpful for the first hour or so. Oral universal antidotes are also ineffective.
What is effective in preventing early damage are compounds that block the body’s conversion of ethylene glycol into its more toxic metabolites. For a long time, that was ethanol (grain alcohol) to tie up the pet's alcohol dehydrogenase enzymes that are required for that toxic process to occur.
Ethanol is still commonly used as the antidote for antifreeze/ethylene glycol poisoning in pets. It is cheap, readily available and very effective in preventing ethylene glycol from forming toxic products. But it does have some drawbacks. It has to be periodically readministered as it is metabolized and lost. The vet has to closely monitor pets that are receiving it to be sure they do not receive toxic amounts. Ethanol in itself can cause coma, respiratory arrest (stop breathing) or liver damage if too much is given.
Ethanol, in itself, can cause undesirable blood changes if it is not well managed (hyperosmolality and metabolic acidosis). Your veterinarian can review treatment guidelines for using ethanol here.
Those drawbacks in the use of ethanol led to development of an alternative
product, fomepizole (4-Methylpyrazole= 4-MP = Antizol).
Fomepizole does not need to be administered as frequently and it
does not have the side effects of ethanol. Fomepizole is not recommended
for use in cats. Its only disadvantage is its expense.
There are other things that must be done:
The pet’s acid-base balance (blood acidity below 7.3) needs to be brought back up to normal. This is done through the administration of fluids that contain sodium bicarbonate and by checking the pet’s urine or blood pH periodically to regulate the amount given.
Things need to be done to speed the removal of ethylene glycol from the pet’s blood before it can break down into toxic products. This means urinating it out of your pet's body. Giving intravenous fluids usually increase urine flow – so fluid administration is important.
If kidney damage has already occurred, the pet will not be able to increase its urine flow. In those cases, a technique called peritoneal dialysis can also help flush out EG. In some large veterinary centers, the same hemodialysis used to cleans the blood of human EG victims can be used on pets as well.
Pets that are already developing life-threatening complications need other support - things like temperature maintenance and airways protection (intubation).m
Some of these pets develop critically low blood calcium levels that can lead to convulsions. Some veterinarians give calcium for this; but others worry that the added calcium will speed the formation of toxic calcium oxalate, so they give anti-seizure medicines like diazepam or midazolam (Valium , Versed).
Pets will usually recover fully if these things are done within 8 hours of drinking ethylene glycol and continued until blood ethylene glycol levels drop into a safe range. The problem is that most cases are not diagnosed and treated that rapidly. After more than 18 hours have passed, neither ethanol nor fomepizole will help because the toxic breakdown products of EG have already been released. Most, or all, of the ethylene glycol has already left your pet’s body by then.
There is no specific treatment that will reverse kidney damage. What one is left with is trying to minimize the damage. At that point, your pet’s fate will rest on the levels of BUN and creatinine in its blood – measurements of how well its kidneys are functioning. Intravenous fluids, peritoneal dialysis, possibly diuretics and stabilization treatments can still help at this time. But recovery will depend on how much the pet's kidneys have been injured and the extent of their ability to recover. God blessed humans and pets with considerably more kidney tissue than their bodies require – that is why kidneys can be donated. If the pet is fortunate and the amount of EG consumed not too large, with treatment or time its body will return to equilibrium.
A kidney transplant is an option. It is an expensive procedure that is only performed at a few large, sophisticated veterinary centers. I would begin by contacting the Center nearest to you that is mentioned in my article on calcium oxalate kidney stones. You can read that here for a dogs and here for cats. If they do not perform kidney transplants, they will tell you who does.
What Can I Do To Prevent My Pets From Consuming Antifreeze ?
Open containers of drained (used) antifreeze and exposure to the spilled liquid, engine leak or flush are a pet hazard throughout the year. (In the US, exposure to ethylene glycol is slightly more common from March to May (ref) ) So dispose of drained or partially used containers promptly and in a safe manner.
Antifreeze fluid usually has a translucent greenish-yellow color - similar to in this photo. Look for any of this material puddling under your vehicles and have the problem attended to promptly by your mechanic.
Soak up spills with cat litter and wash the garage floor with detergent. Most antifreeze leave a residue that will glow under ultraviolet light.
Alternative car antifreezes that do not contain ethylene glycol (they contain less-toxic propylene glycol or glycerin) are available.
Never pour or store antifreeze in a container that was once used
for something else.
As of 2010, ten states require that a bittering agent, denatonium benzoate (Bitrex) , be added to all antifreeze to make it taste bad. The hope was that doing so would prevent human and pet poisoning. Denatonium benzoate is an atrocious-tasting material. I have accidentally tasted it many times and it tastes simply horrible. A law to make it a compulsory addition to all antifreeze sold in the USA failed to pass Congress in 2010. In theory, universally adding it should be helpful. However, it is the same agent that is used in products sprayed on pets to discourage licking and my experience with those sprays is that they are usually quite ineffective. The same lack of effectiveness of denatonium benzoate was reported in children. (ref)
Pets are less likely to consume antifreeze if they are not thirsty. Give them plenty of water before taking them out-of-doors and carry extra water along for long trips. Thirsty dogs will lap at water that is contaminated with many bad things (e.g. leptospirosis).
You are always safer walking your pets on a leash rather than loose. Dogs that are off-leash are exposed to considerably more hazards of all types than those that are under control. Of course, your pet’s specific personality and the current location are quite important as well.
If you are suspicious that a puddle or stain may be contaminated with ethylene glycol, check it with a UV lamp (Black light = Woods or Disco lamp) under low lighting. Ethylene glycol has a low vapor pressure which means it does not evaporate or dissipate much over time - so it hangs around.
Police and high risk search and rescue dogs are more likely to be exposed. Keep a UV light on hand or teach aversion (similar to rattlesnake avoidance).
Be a considerate neighbor – if only to protect your pet. Do not allow your dog to bark at night, roam the neighborhood, harass your neighbor when she goes out to check the mail, scare her cats or dig up her flower bed. Do not allow your cats to waylay birds under your neighbor’s bird feeder, yowl at night, breed indiscriminately or poop in their flowerbed or sandbox. Not all cases of antifreeze poisoning are accidental.
Contact Dr. Hines
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