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Case Reports
. 2024 May 16;5(3):e13188.
doi: 10.1002/emp2.13188. eCollection 2024 Jun.

Propylene glycol toxicity in an adolescent secondary to chronic cornstarch ingestion

Kristen Downey  1 , Ryan Keklik  2 , Benjamin Morrissey  2 , Robert Barnes  2 , Karina Reyner  2 , Michael Emmett  3
Affiliations
Case Reports

Propylene glycol toxicity in an adolescent secondary to chronic cornstarch ingestion

Kristen Downey et al. J Am Coll Emerg Physicians Open. .

Abstract

Propylene glycol (PG) is a diol (a double alcohol) that is commonly used as a food additive to preserve shelf life and enhance flavors, texture, and appearance. Although PG makes up only a small percentage of cornstarch, ingestion of large doses can cause lactic acidosis leading to hyperosmolarity, high anion gap metabolic acidosis (HAGMA), and a sepsis-like syndrome. A 17-year-old female presented to our emergency department (ED) with chronic chest pain, dyspnea, nausea, and vomiting. Laboratory testing showed an elevated anion gap of 18 mEq/L with no osmolar gap. Toxicology screening was negative. Twelve hours after ED arrival, she admitted to consuming one box of cornstarch daily for the past 6 months. She was admitted to the intensive care unit (ICU) with multisystem organ failure due to propylene glycol toxicity. After empiric treatment with fomepizole and continuous renal replacement therapy, her clinical status gradually improved. This case highlights the importance of obtaining a thorough dietary history in patients with suspected toxicities, especially when laboratory values demonstrate an unexplained HAGMA and/or lactic acidosis. Prompt recognition and therapeutic intervention with fomepizole, a potent inhibitor of alcohol dehydrogenase, is essential in reducing life-threatening sequelae following toxic alcohol ingestions.

Keywords: anion gap metabolic acidosis; cornstarch; lactic acidosis; propylene glycol; toxic alcohol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Metabolic pathway of propylene glycol. ADH, alcohol dehydrogenase; ALDH, aldehyde dehydrogenase.
See this image and copyright information in PMC

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