Ethylene glycol [monobutyl ether] exposure

Ethylene glycol monobutyl ether (also called 2-butoxyethanol or butyl cellosolve) is NOT the same thing as ethylene glycol! 

You might want to search medline for references on "glycol ethers." This stuff has been shown to cause hemolytic anemia in rats although the "party line" is that it doesn't affect people much. 

In my opinion the party line is wrong. One subset of people who have very strong reactions, similar to the patient you describe, are people who describe their problem as multiple chemical sensitivities (MCS). I found that a lot of these MCS patients have abnormal enzyme kinetics for a red blood cell enzyme, pyruvate kinase, which is one of the major causes of inherited hemolytic anemia worldwide. 

Mark Cullen et al. at Yale found blood or bone marrow abnormalities in a subset of printers and shipyard workers exposed to ethylene glycol monobutyl ether. Further investigation revealed abnormal pyruvate kinase enzyme kinetics in conjunction with abnormal blood/bone marrow tests in ca. 10% of exposed shipyard workers. A sample of exposed workers with no blood/bone marrow abnormalities all had normal pyruvate kinase activity. Which implies to me that we may have a relatively large subpopulation who can't tolerate this stuff because of an underlying subtle defect in the pyruvate kinase enzyme or related biochemical pathways... Regards, 

Patricia P. Wilcox,

MS School of Public Health

The Ohio State University.

Here's one to kick around: A 55 y/o maintenance/repair man working in a "dyehouse" is asked to clean the inside of a (roughly) 36 sq. ft. metal enclosure (part of a machine known as a "Jig"), with a spray bottle filled with undiluted "Super D" (the MSDS of which only lists ethylene glycol monobutyl ether (>3%) and potassium hydroxide; the rest being proprietary). 

Over the 6 hours that he is in the enclosure (apparently cleaning off old hydraulic oil and grease), he uses perhaps 1-2 gallons of the stuff. He exits feeling mildly lightheaded and unsteady. Over the next few hours, he becomes very nauseated, vomits several times, feels unsteady/vertiginous, and mildly short of breath. 

His wife notices that he appears "red in the face". The enclosure is open (via a door) to the outside, and the machine with the enclosure sits within a large warehouse, without adjacent manufacturing occurring. There is no apparent CO source (??). This exposure occurs in April. 

He is admitted the next day, but only limited labs (nl chem, CBC, U/A, CXR and EKG) are obtained. His initial presentation is with BP 132/78, pulse 80, resp rate 20, afebrile. Pin point pupils, nystagmus, and tandem gait difficulties are only abnormalities noted. Since then, a brain MRI and CT are wnl. He remains out of work. He continues to experience: decreased concentration, memory, irritability, unsteady gait (not vertigo), non-dermatomal sensory loss to hands and feet (only noted during exam), mild exertional shortness of breath (nl chest ct and pft), occasional diarrhea. His PMH is entirely negative (non-drinker and smoker). He has no hobbies (cares for invalid wife). The only other known work exposure is to two to three scoops of Sodium sulfite, which he adds daily to 190 degree water bath. In fact, he did this right after working in the enclosure on the date of "exposure". No ingestion of ethylene glycol, no use of ppe, and poor ventilation. Any thoughts? 

R. Updegrove, M.D.

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