Poisoning from ethylene glycol is a potentially lethal medical emergency but can be treated effectively when recognized early. Conversely when diagnosis is late, the outcome is usually poor. The major pathogenic factor is metabolic acidosis from glycolic acid (glycolate). Because laboratory testing for ethylene glycol and glycolate is severely restricted, timely diagnosis depends on comparatively nonspecific physical signs and laboratory tests. Lack of access to specific testing and need for differentiation from conditions featuring similar symptoms constitute a unique medical dilemma. Recognizing these deficiencies we propose to develop novel, specific enzymic assays for ethylene glycol and glycolate. Two product configurations are perceived: (1) aqueous reagents for existing clinical analyzers (serum, quantitative); (2) a dry-chemistry, dual-analyte point-of-care test strip method (whole blood, semi-quantitative). Because of rapid metabolism of (nontoxic) ethylene glycol and the longer half life of (toxic) glycolate, the latter provides: (1) better prognostic information; (2) improved clinical sensitivity, especially late post-ingestion. Thus, rapid and simultaneous availability of test results for both analytes expands the window of diagnostic/therapeutic opportunity. Socioeconomic benefits are: (1) reducing expensive gas chromatographic screening, confirmatory and other testing; (2) averting late or unnecessary treatment; (3) cutting intensive care and hospital stay; (4) abating long-term morbidity (renal dialysis).
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