Multi-organ toxicity

This substance is a liquid used in antifreeze, paints, polishes, and cosmetics. As it has a sweet taste and is readily available it has been used as a poor man s alcohol, but it may also be ingested accidentally and for suicidal purposes. Diethylene glycol was once used as a vehicle for the drug sulfanilamide, and when used for this, it caused some 76 deaths. 

The minimum lethal dose of ethylene glycol is about 100 mL, and after ingestion, death may occur within 24 hours from damage to the CNS or more slowly (8-12 days) from renal failure. 

There seem to be three recognizable clinical stages  

Within 30 minutes and lasting for perhaps 12 hours, there is intoxication, nausea, vomiting, coma, convulsions, nystagmus, papilledema, depressed reflexes, myoclonic jerks, and tetanic contractions. Permanent optic atrophy may occur. 

Between 12 and 24 hours, there is tachypnea, tachycardia, hypertension, pulmonary edema, and congestive cardiac failure. 

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Thus, cadmium causes multi-organ toxicity, and at least some of the toxic effects are due to it being a divalent metal similar to zinc and able to bind to sulfydryl groups. 

Lead is a toxic metal to which there is wide exposure. Exposure is via inhalation (main source, leaded petrol) and ingestion (water, old paint). Multi-organ toxicity occurs with the kidneys, central and peripheral nervous system, testes, red cells, bones, and gastrointestinal tract all damaged. After initial distribution into red blood cells, it is eventually deposited in bone. The main biochemical effect is interference with heme synthesis at several points. Kidney toxicity may be due to lead-protein complexes and inhibition of mitochondrial function. Damage to nerves leads to peripheral neuropathy. 

Many of the reactions to sulfonamides involve the skin and mucous membranes. The more severe reactions that occur include potentially lethal toxidermias and a delayed hypersensi-tivity-type syndrome characterized by fever, skin rash, and multi-organ toxicity, hnmediate type I reactions are the most well-defined sulfonamide-induced hypersensitivity reactions with the best defined allergenic drug structmes. Sulfonamides with one methyl substituent on a five- or six-membered aromatic heterocyclic ring on the carbon p to the sulfon-amido substituent are the structmes most complanentary to anti-sulfamethoxazole IgE antibody combining sites. 

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