From Big Medical Encyclopedia

ANTIFREEZE (grech, anti-against English freeze to freeze) — the liquid applied to cooling of internal combustion engines and other installations during the work in cold when the water used for this purpose can freeze. Structure And. can be various. More often it is aqueous solutions of ethylene glycol or alcohols, a number of salts, etc. And. domestic production of V-2 (not freezing at t ° — 40 °) are 55% aqueous solution of ethylene glycol with addition for prevention of metallic corrosion of 0,3% of sodium phosphate and 0,1% of a dextrin.

For receiving the antifreeze which is not freezing at t ° — 65 ° below, prepare triple mixes, napr, ethylene glycol of 50%, alcohol of 30% and water of 20%. In addition to domestic And., exist And. the American production (Preston) and German (glizantin), made on the basis of ethylene glycol.

Ethylene glycol — viscous siropoobrazny colorless or inodorous yellowish opalescent liquid, sweetish taste. Let's well dissolve in water, alcohol, acetone, glycerin, it is bad — on air, chloroform, benzene; t°kip 197,6 °; density 1,113; reaction alkalescent; possesses a small volatility; steam tension of 0,09 mm of mercury. at t°20 °. It turns out accession of water to ethylene oxide. In addition to use for production And., ethylene glycol is used in the industry as a raw product by production of a number of solvents (tsellosolv and its esters, dioxane, etc.) » for replacement of glycerin. Ethylene glycol and other glycols are used as plasticizers for binding substances in production of cellophane, polyethers, etc. Ethylene glycol is applied also in the textile, tanning, tobacco, paint-and-varnish, pharmaceutical, perfumery industry, etc. At intake ethylene glycol works as the vascular and protoplasmatic poison causing hypostasis, swelling and a necrosis of cells of fabrics. At a single dose of 50 ml there are symptoms of acute poisoning, and the dose of 100 — 150 ml is deadly to people. Ethylene glycol possesses the expressed toxic action on ts.n. page, kidneys, a liver, vessels, causing dystrophic changes in these bodies.

In an organism ethylene glycol is oxidized to oxalic to - you, waters and carbonic acids. Are formed also hydroxy-acetaldehyde, glioksalevy and glycolic to - you. Being soaked up from went. - kish. a path, ethylene glycol in 5 — 15 min. appears in blood, and in an hour — in urine. The maximum content of ethylene glycol in blood after intake is observed in 2 — 5 hour.

Being soaked up in blood, ethylene glycol in 30 min. causes signs of intoxication. After the period of intoxication during 3 — 12 hours (depending on a dose) the good health (the refractory period) remains. Sometimes right after reception of ethylene glycol vomiting, pain in epigastric area and a waist, a fever inside develops. Upon termination of the refractory period there comes the phase of the brain phenomena: the general weakness, a headache, dizziness, nausea, vomiting, motive excitement, areflexias, spasms, a Crocq's disease, blackout and a loss of consciousness, are noted disturbances of cordial activity and breath (expansion of borders of heart, muting of tones, bradycardia, lowering of arterial pressure, an urezheniye of breath and so forth), expansion of pupils, their weak photoharmose, increase and morbidity of a liver takes place. On an ECG the sinus arrhythmia, shift of a tooth of T, sometimes a two-phase tooth of T and an atrioventricular block is noted. In blood — a neutrophylic leukocytosis, the accelerated ROE; in red blood unripe forms appear. In urine — traces of protein, in draft erythrocytes, leukocytes, hyaline and granular cylinders, oxalates, reaction sharply acid. In 1 — 2 days in hard cases there comes coma and death at the phenomena of an apnoea. Sometimes death comes because of a sudden cardiac standstill with a standard arterial atmosphere pressure (giperkaliyemichesky paralysis because of increase in plasma of potassium concentration).

If the patient endured a phase of the brain phenomena, consciousness is returned, but weakness, headaches remains, face reddening, fervescence (from 37,5 to 38 °), thirst is noted. Sometimes after nek-ry improvement of a state, in 2 — 5 days (sometimes through 15 — 20) after intake of poison, poisoning passes into the following phase — hepato-renal. This phase is characterized by the oliguria (passing into an anury), an albuminuria, a hamaturia, an azotemia, uraemia, uraemic colitis, a hypertension. The patient complains of back pains and the right hypochondrium. Pasternatsky's symptom sharply positive, the liver increased and painful, thirst. Urine muddy, amount of protein to 40%o, in draft fresh and lixivious erythrocytes, cylinders, crystals of oxalates. Acidosis, breath rigid, in lungs various rattles. Complications: hematencephalons, necrosis of bark of adrenal glands and kidneys, toxic dystrophy of a liver, sepsis. Death comes on 10 — the 30th days from uraemia, is frequent in combination with pneumonia.

Pathomorphologic changes correspond to clinical forms of intoxication. The persons who died in a brain phase have poisonings — the expressed plethora of parenchymatous bodies and a brain, dot hemorrhages, disturbance of structure of brain fabric, dystrophic changes in nervous cells, kidneys, a liver. In a hepato-renal phase — fibrous and ulcer colitis, increase in a liver, granular and gidropichesky dystrophy and a necrobiosis of hepatic cells in the center of segments, in lungs — the centers of pneumonia. In kidneys in the first two days — the moderate granular dystrophy of an epithelium of proximal gyrose tubules which is replaced by a heavy gidropiya of an epithelium and its necrosis. In gyrose and direct tubules — crystals of oxalates, in an epithelium of tubules — deposits of lime. In vessels of kidneys — hypostasis and a loosening of walls, splitting or fragmentation of elastic membranes, swelling of endothelial cells. In gleams of arteries — blood clots.

First aid at poisoning — gastric lavage, siphon enemas, rest, heat, oxygen, bloodlettings (200 — 400 ml); administration of alkalis (under skin kapelno 0,5 — 1 l of 3 — 4% of soda solution or inside on 2 g of baking soda each hour) before alkalescent reaction of urine, magnesium sulfate intramusculary or intravenously (on 5 ml of 25% of aqueous solution), glucose on 20 — 40 ml of 25 — 40% of solution intravenously; cardiacs.

Prevention of poisonings. On a container for And. the text large letters indelible YAD paint and the sign established for poisons shall be. During transportation and storage And. all drain, bulk and air openings in a container shall be sealed up. Empties from under And. it is also immediately sealed up. Delivery And. in motor transport services for gas station of cars it is made only according to specially issued requirements and only in the cooling system of engines; storage And. in a container owners of cars have enough. With approach of warm time and before car repairs And. it is necessary to merge from the cooling system of the engine in a container and to zaprikhodovat under the act. Rules of the storage fulfilled And. the same. All workers of motor transport services before use And. undergo instructing and an examination in rules of use And. On foregrounds the corresponding posters and instructions are hung out. To owners of cars at issue And. from columns the instruction with rules on its use is given.

Antifreeze in the medicolegal relation

Court. - the medical proof of poisonings And. is based on the given morphological changes of fabrics and the chemical analysis. And. for the analysis allocate with distillation of contents of a stomach, went. - kish. a path, parenchymatous bodies with water vapor in the presence of the selective solvent or extraction by benzene. Chemical definition allocated And. it is based on detection of products of its oxidation. Oxidation is made in two main ways: repeated processing during the heating concentrated nitric to - that to oxalic to - you and periodate in the sulfate environment to formaldehyde. For detection oxalic to - you microcrystallic reactions of formation of calcium oxalates and silver (a characteristic form of crystals have the greatest value at observation under a microscope). Formaldehyde is defined by reactions of coloring with fuksinsernisty or chromotropic to - that.

See also Departures .

Bibliography: Buravsky T. M., etc. About treatment of patients with the acute renal failure caused by poisoning with antifreeze, Urol. and nefrol., Jsß 1, page 48, 1967; Viksnin Yu. S. Acute poisonings with ethylene glycol, Klin, medical, t. 42, No. 4, page 123, 1964; Darovsky B. P Damage of an epithelium of tubules of kidneys at poisoning with ethylene glycol, the Doctor, business, No. 5, page 134, 1970; Kanshina Η. T. and D and r about in with to and y B. P. The acute renal failure caused by poisoning with ethylene glycol, Urol. and nave-rol., No. 2, page 51, 1969.

L.S. Rozanov; A. F. Rubtsov (court.).