Glycols (Ethylene and Propylene)
Label Mnemonic: GLYCOL
Epic Lab Code: LAB615
Downtime Form: A-1a Miscellaneous Request
Chemistry
6240 RCP
356-3527
Specimen(s):
Plasma
Collection Medium:
Plasma Separator Tube 4.5 mL
Alternate Collection Media:
Call laboratory for additional acceptable specimen collection containers.
Minimum:
3 mL whole blood from light green top tube or TWO Microtainer® devices for pediatric patients
Rejection Criteria:
Medico-legal specimens are not accepted.
Testing Schedule:
0700-1530 Monday through Friday. For additional services, contact Clinical Pathology Resident on-call at pager #3404.
Turn Around Time:
4 hours (upon receipt in laboratory)
Reference Range:
Ethylene glycol toxicity usually >50 mg/dL

Clinical toxicity: >10 mg/dL

Propylene glycol toxicity range not well defined but clinical toxicity more likely if plasma concentration exceed 100 mg/dL.

Critical values:
  Ethylene glycol 10 mg/dL or greater
  Propylene glycol 100 mg/dL or greater
Comments:
This test requires approval of Clinical Pathology Resident on-call (pager #3404).

Note that the "Ethylene Glycol, Plasma" provides more rapid determination of ethylene glycol plasma concentrations. The "Ethylene Glycol, Plasma" test is reflexively ordered if the unexplained osmolar gap is greater than 15 and may also be directly ordered in cases of suspected ethylene glycol ingestion or for monitoring ethylene glycol plasma concentrations in patients receiving treatment for ethylene glycol ingestion. This procedure individually quantitates ethylene glycol.

The glycols by gas chromatography tests may be ordered if there is an interference with the "Ethylene Glycol, Plasma" test or if quantitation of propylene glycol is needed. This procedure individually quantitates ethylene glycol and propylene glycol. Ethylene glycol is commonly found in many automobile antifreezes. Propylene glycol is found in some intravenous drug formulations as a solvent/diluent (e.g., diazepam, lorazepam, etomidate, and phenytoin) and is also found in a small number of automobile antifreezes (e.g., Sierra).

References:
(1) Wilson KC, Reardon C, Theodore AC, and Farber HW.  Propylene glycol
    toxicity: a severe iatrogenic illness in ICU patients receiving IV
    benzodiazepines: a case series and prospective, observation l pilot
    study.  Chest 128: 1674-1681, 2005.

(2) Eder AF et al.  Ethylene glycol poisoning: toxicokinetic and
    analytical factors affecting laboratory diagnosis.  Clin Chem 
    44: 168-177, 1998.

(3) Juenke JM et al. Rapid and specific quantification of ethylene
    glycol levels: adaptation of a commercial enzymatic assay to
    automated chemistry analyzers. Am J Clin Pathol 136: 318-324, 2011.

(3) Lynd LD et al. An evaluation of the osmole gap as a screening test
    for toxic alcohol poisoning. BMC Emerg Med 8: 5, 2008. 

Profile result codes:  GLYC, PGLY
Methodology:
Gas Chromatography
CPT Code:
80320