Antifreeze, commonly used as engine coolant, presents a severe health hazard if it enters the body. This substance typically contains ethylene glycol or methanol, both of which are highly toxic, even in small amounts. Ingestion or exposure to the mouth is a medical emergency requiring immediate professional intervention. Prompt action is crucial, as the time between exposure and treatment directly relates to the potential for organ damage.
Immediate First Aid Steps
The first response to antifreeze exposure in the mouth is to spit out any liquid immediately to prevent further ingestion. Following this, the mouth should be rinsed thoroughly multiple times using clean water. Ensure the rinse water is also spit out and not swallowed, as ingesting even a small amount of the diluted solution can be dangerous.
If the liquid has splashed onto the skin or clothing, remove the contaminated clothing promptly. Wash the affected skin area with soap and generous amounts of water. If liquid splashed into the eyes, rinse them for at least 15 to 20 minutes.
Do not attempt to induce vomiting unless a medical professional or Poison Control Center specifically instructs this action. Inducing vomiting risks aspiration of the toxic chemical into the lungs, causing further injury. These initial steps limit exposure while professional medical help is en route.
Seeking Professional Help and Reporting the Incident
Once immediate physical steps are taken, the next priority is contacting professional medical assistance. In the United States, call the national toll-free Poison Help hotline at 1-800-222-1222, which connects to the local Poison Control Center. This service is available 24 hours a day and provides free, confidential expert guidance based on the specific exposure.
If the person shows immediate symptoms, such as difficulty breathing, seizures, or loss of consciousness, call 911 or your local emergency number immediately. Prompt reporting is crucial for a better potential outcome. When speaking with the specialist or emergency operator, be prepared to provide specific details:
- The exact product consumed (have the container or a photograph of the label available).
- The estimated amount of antifreeze the person was exposed to.
- The time the exposure occurred.
- The individual’s age and weight.
- A clear description of any symptoms that have appeared, such as nausea, confusion, or lack of coordination.
Why Antifreeze is Extremely Toxic
Antifreeze is toxic not primarily because of the parent compound, ethylene glycol, but rather its metabolic byproducts. Ethylene glycol is a colorless, odorless liquid with a sweet taste, which contributes to accidental ingestion. Once inside the body, the liver enzyme alcohol dehydrogenase (ADH) begins to metabolize the ethylene glycol.
This metabolic process converts the parent compound into a series of highly toxic substances, beginning with glycolaldehyde, then progressing to glycolic acid. Glycolic acid is responsible for the severe metabolic acidosis, or excessive blood acidity, which develops after ingestion. The accumulation of these organic acids causes many early neurological and cardiopulmonary symptoms.
The final and most damaging metabolite is oxalic acid, which readily binds with calcium in the bloodstream. This chemical reaction forms insoluble calcium oxalate crystals that accumulate and deposit in various organs, most notably the kidneys and brain. The deposition of these crystals in the renal tubules leads directly to acute kidney injury and eventual renal failure, often the most delayed and fatal phase of the poisoning.
Hospital Treatment Protocols
Treatment for antifreeze poisoning focuses on blocking the toxic metabolism and removing the poison from the body. Initial care involves stabilizing the patient, monitoring vital signs, and correcting severe metabolic acidosis through intravenous sodium bicarbonate. Blood and urine tests confirm the presence and concentration of ethylene glycol and its metabolites.
The primary medical intervention is the administration of an antidote designed to interfere with the ADH enzyme. The preferred treatment is Fomepizole, which acts as a potent inhibitor of alcohol dehydrogenase, preventing the formation of harmful glycolic and oxalic acids. Fomepizole is generally safer and easier to use than the historical alternative, ethanol, which also blocks the ADH enzyme.
If the patient presents with advanced poisoning, severe acidosis, or evidence of kidney damage, hemodialysis becomes necessary. Hemodialysis physically filters the blood, effectively removing unmetabolized ethylene glycol and already-formed toxic metabolites, such as glycolic acid. This procedure reduces the toxin load and can be life-saving by preventing permanent kidney failure.