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ETHOXYETHOXY ETHANOL

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Ethoxyethoxy ethanol (diethylene glycol monoethyl ether [DGEE]) is used primarily as an industrial solvent.

Specific Substances

    1) Diethylene glycol ethyl ether
    2) Diethylene glycol monoethyl ether
    3) Diglycol monoethyl ether
    4) Ethoxydiglycol
    5) Ethyl digol
    6) 2-(2-Ethoxyethoxy)ethanol
    7) DGEE
    8) CAS 111-90-0
    9) Molecular Formula: C5-H14-O3
    10) NIOSH/RTECS KK 8750000
    11) LOSUNGSMITTEL AV
    1.2.1) MOLECULAR FORMULA
    1) C6-H14-O3

Available Forms Sources

    A) FORMS
    1) NOTE: Commercial products often contain ethylene glycol.
    B) USES
    1) Ethoxyethoxy ethanol (diethylene glycol monoethyl ether [DGEE]) is a solvent with a wide variety of industrial uses (ie, cellulose esters, lacquer and thinner formulations, oil-water compositions, various resins, inks, printing pastes, protective coatings, textile dyeing and printing, cosmetics, toiletries, cleaning compositions, quick drying varnishes and enamels, and wood stains). It is also used as a chemical intermediate and as a diluent for hydraulic brake fluid. Purified ethoxyethoxy ethanol is used in numerous pharmaceutical formulations administered by oral, topical and/or rectal/vaginal routes (Scientific Committee on Consumer Safety, 2013; Bingham et al, 2001; Budavari, 1996).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Ethoxyethoxy ethanol (diethylene glycol monoethyl ether) is a solvent with a wide variety of industrial uses (ie, cellulose esters, lacquer and thinner formulations, oil-water compositions, various resins, inks, printing pastes, protective coatings, textile dyeing and printing, cosmetics, toiletries, cleaning compositions, quick drying varnishes and enamels, and wood stains). It is also used as a chemical intermediate and as a diluent for hydraulic brake fluid. Purified ethoxyethoxy ethanol is used in numerous pharmaceutical formulations administered by oral, topical and/or rectal/vaginal routes.
    B) TOXICOLOGY: Ethoxyethoxy ethanol [2-(2-ethoxyethoxy) ethanol] is primarily metabolized to 2-(2-ethoxyethoxy) acetic acid (2-EEAA) of which 68% is eliminated in the urine.
    C) EPIDEMIOLOGY: Exposure is rare; significant human toxicity has not been reported.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Topical exposure to pure ethoxyethoxy ethanol was well tolerated with only skin reddening in less than 7 healthy volunteer subjects following a 3-day application.
    2) SEVERE TOXICITY: One case report of massive oral overdose has been reported. A 44-year-old alcoholic man ingested approximately 2 mL/kg (2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression.
    0.2.20) REPRODUCTIVE
    A) At the time of this review, no reproductive studies were found for carbitol in humans.
    0.2.21) CARCINOGENICITY
    A) At the time of this review, no studies were found on the possible carcinogenic activity of carbitol in humans or experimental animals.

Laboratory Monitoring

    A) Monitor vital signs and mental status.
    B) Monitor serum electrolytes, renal function and liver enzymes in symptomatic patients and those with large ingestions.
    C) Monitor venous or arterial blood gases regularly in symptomatic patients.
    D) Monitor for respiratory depression.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Supportive care with attention to monitoring for metabolic acidosis and CNS depression.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Supportive care with attention to monitoring for CNS and respiratory depression, metabolic acidosis, acute kidney injury.
    C) DECONTAMINATION
    1) PREHOSPITAL: Gastrointestinal decontamination is not recommended because of the potential for CNS depression and subsequent aspiration. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate exposed eyes with water.
    2) HOSPITAL: Gastrointestinal decontamination is not recommended because of the potential for CNS depression and subsequent aspiration. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate exposed eyes with 0.9% saline.
    D) AIRWAY MANAGEMENT
    1) Monitor for respiratory depression. Endotracheal intubation may be necessary in patients with severe CNS depression or respiratory failure.
    E) ANTIDOTE
    1) None.
    F) ENHANCED ELIMINATION PROCEDURE
    1) It is not known if ethoxyethoxy ethanol is removed by hemodialysis or hemoperfusion. Hemodialysis should be considered in patients with severe metabolic acidosis or renal failure.
    G) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients with inadvertent ingestion who are asymptomatic can be monitored at home.
    2) OBSERVATION CRITERIA: Symptomatic patients and those with deliberate ingestions should be referred to a healthcare facility.
    3) ADMISSION CRITERIA: Patients with severe metabolic acidosis, renal failure or respiratory depression should be admitted to intensive care.
    4) CONSULT CRITERIA: Consult a medical toxicologist or poison center for patients with significant toxicity or in whom the diagnosis is in question.
    H) PITFALLS
    1) Significant toxicity has only been reported once after deliberate ingestion. Do not overtreat.
    I) TOXICOKINETICS
    1) Well absorbed orally. Majority (68%) of metabolites, 2-EEAA, were eliminated in urine after ingestion.
    J) DIFFERENTIAL DIAGNOSIS
    1) Consider ingestion of toxic alcohols including methanol, ethylene glycol, diethylene glycol. Sepsis and other infectious etiologies may cause metabolic acidosis, renal impairment and CNS/respiratory depression.

Range Of Toxicity

    A) TOXICITY: Based on extrapolation from animal data, it has been suggested that 91 mL could be lethal in a 70 kg man. However, case report data demonstrated recovery in a patient who ingested 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg).

Clinical Effects

Summary Of Exposure

    A) USES: Ethoxyethoxy ethanol (diethylene glycol monoethyl ether) is a solvent with a wide variety of industrial uses (ie, cellulose esters, lacquer and thinner formulations, oil-water compositions, various resins, inks, printing pastes, protective coatings, textile dyeing and printing, cosmetics, toiletries, cleaning compositions, quick drying varnishes and enamels, and wood stains). It is also used as a chemical intermediate and as a diluent for hydraulic brake fluid. Purified ethoxyethoxy ethanol is used in numerous pharmaceutical formulations administered by oral, topical and/or rectal/vaginal routes.
    B) TOXICOLOGY: Ethoxyethoxy ethanol [2-(2-ethoxyethoxy) ethanol] is primarily metabolized to 2-(2-ethoxyethoxy) acetic acid (2-EEAA) of which 68% is eliminated in the urine.
    C) EPIDEMIOLOGY: Exposure is rare; significant human toxicity has not been reported.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Topical exposure to pure ethoxyethoxy ethanol was well tolerated with only skin reddening in less than 7 healthy volunteer subjects following a 3-day application.
    2) SEVERE TOXICITY: One case report of massive oral overdose has been reported. A 44-year-old alcoholic man ingested approximately 2 mL/kg (2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression.

Heent

    3.4.3) EYES
    A) WITH POISONING/EXPOSURE
    1) CONJUNCTIVITIS: Mild to moderate conjunctival irritation has been reported in rabbits following ocular exposure (Bingham et al, 2001; RTECS , 2001).

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) ACUTE RESPIRATORY INSUFFICIENCY
    1) WITH POISONING/EXPOSURE
    a) Respiratory depression may occur (Brennaas, 1960).
    b) CASE REPORT: A 44-year-old alcoholic man ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) CENTRAL NERVOUS SYSTEM DEFICIT
    1) WITH POISONING/EXPOSURE
    a) CNS depression may occur (Brennaas, 1960).
    b) CASE REPORT: A 44-year-old alcoholic man ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).

Hepatic

    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATIC NECROSIS
    a) Centrilobular necrosis has been observed in animals (Hanzlik et al, 1947).

Genitourinary

    3.10.2) CLINICAL EFFECTS
    A) ALBUMINURIA
    1) WITH POISONING/EXPOSURE
    a) Albuminuria, oliguria, and uremia may be noted (Brennaas, 1960).
    b) CASE REPORT: A 44-year-old alcoholic man ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).
    B) RENAL IMPAIRMENT
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: A 44-year-old man alcoholic ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).
    3.10.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) RENAL TUBULAR NECROSIS
    a) MICE: In mice, hydropic renal tubular necrosis is the most common manifestation of toxicity (Hanzlik et al, 1947).

Acid-Base

    3.11.2) CLINICAL EFFECTS
    A) ACIDOSIS
    1) WITH POISONING/EXPOSURE
    a) Metabolic acidosis may be noted (Brennaas, 1960), but is not as common as with ethylene glycol.
    b) CASE REPORT: A 44-year-old alcoholic man ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).

Hematologic

    3.13.2) CLINICAL EFFECTS
    A) HEMOLYSIS
    1) WITH POISONING/EXPOSURE
    a) Hemolysis may be noted.

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) WITH POISONING/EXPOSURE
    a) Ethoxyethoxy ethanol is nonirritating to skin even upon prolonged and repeated contact (Bingham et al, 2001).
    B) ERYTHEMA
    1) WITH POISONING/EXPOSURE
    a) In one study, 0.02 mL (undiluted) of ethoxyethoxy ethanol (Transcutol) was applied on a surface of about 50 mm(2) of skin on the back of 10 volunteers under occlusive patch test conditions for 48 hours. Erythema of grade 1 out of 4 grades (ie, very slight) was observed in only one volunteer. All other volunteers had no erythema (Scientific Committee on Consumer Safety, 2013).
    b) Topical exposure to pure ethoxyethoxy ethanol was well tolerated with only skin reddening in less than 7 healthy volunteer subjects following a 3-day application (Cranch et al, 1942).
    C) DISORDER OF SKIN
    1) WITH POISONING/EXPOSURE
    a) PERCUTANEOUS ABSORPTION: Diethylene glycol ethers were found to cross human skin at a slower rate than their corresponding monoethylene glycol equivalents in an in vitro model (Dugard et al, 1984).

Reproductive

    3.20.1) SUMMARY
    A) At the time of this review, no reproductive studies were found for carbitol in humans.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) LACK OF EFFECT
    a) Ethoxyethoxy ethanol was not embryotoxic in rats exposed to 100 ppm by inhalation (Nelson et al, 1984).
    3.20.3) EFFECTS IN PREGNANCY
    A) ANIMAL STUDIES
    1) LACK OF EFFECT
    a) Ethoxyethoxy ethanol was not maternally toxic in rats exposed to 100 ppm by inhalation (Nelson et al, 1984).
    b) Carbitol was not embryotoxic or fetotoxic in rats exposed by the dermal route (Hardin, 1984). There were no adverse reproductive effects seen in mice which had received the high dose of 5500 mg/kg orally, even though some maternal toxicity was seen (Piccirillo, 1983). In mice, carbitol has affected newborn growth statistics, litter size, and live birth index, and has caused abnormalities of the urogenital system (RTECS , 1996). It was not embryotoxic by inhalation in rats (Nelson et al, 1984). Two other reproductive studies were done in experimental animals, but the results were not available at the time of this review (p 183) Schuler et al, 1984).

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS111-90-0 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
    1) Not Listed
    3.21.2) SUMMARY/HUMAN
    A) At the time of this review, no studies were found on the possible carcinogenic activity of carbitol in humans or experimental animals.
    3.21.3) HUMAN STUDIES
    A) LACK OF INFORMATION
    1) At the time of this review, no data were available to assess the carcinogenic potential of this agent.

Genotoxicity

    A) At the time of this review, no genetic studies were found for carbitol.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Monitor vital signs and mental status.
    B) Monitor serum electrolytes, renal function and liver enzymes in symptomatic patients and those with large ingestions.
    C) Monitor venous or arterial blood gases regularly in symptomatic patients.
    D) Monitor for respiratory depression.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients with severe metabolic acidosis, renal failure or respiratory depression should be admitted to intensive care.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients with inadvertent ingestion who are asymptomatic can be monitored at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a medical toxicologist or poison center for patients with significant toxicity or in whom the diagnosis is in question.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Symptomatic patients and those with deliberate ingestions should be referred to a healthcare facility.

Monitoring

    A) Monitor vital signs and mental status.
    B) Monitor serum electrolytes, renal function and liver enzymes in symptomatic patients and those with large ingestions.
    C) Monitor venous or arterial blood gases regularly in symptomatic patients.
    D) Monitor for respiratory depression.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Prehospital gastrointestinal decontamination is not recommended because of the potential for CNS depression and subsequent aspiration. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate exposed eyes with water.
    6.5.2) PREVENTION OF ABSORPTION
    A) Gastrointestinal decontamination is not recommended because of the potential for CNS depression and subsequent aspiration.
    6.5.3) TREATMENT
    A) MONITORING OF PATIENT
    1) Monitor vital signs and mental status.
    2) Monitor serum electrolytes, renal function and liver enzymes in symptomatic patients and those with large ingestions.
    3) Monitor venous or arterial blood gases regularly in symptomatic patients.
    4) Monitor for respiratory depression.
    B) ACIDOSIS
    1) METABOLIC ACIDOSIS: Treat severe metabolic acidosis (pH less than 7.1) with sodium bicarbonate, 1 to 2 mEq/kg is a reasonable starting dose(Kraut & Madias, 2010). Monitor serum electrolytes and arterial or venous blood gases to guide further therapy.
    C) ETHANOL
    1) The metabolism of ethoxyethoxy ethanol has not been adequately studied. Although the majority is oxidized, symptoms have not been correlated to specific metabolites and acidosis is rare. There is no evidence that alcohol dehydrogenase is involved in metabolism, thus ethanol treatment is not advised.

Enhanced Elimination

    A) HEMODIALYSIS
    1) It is not known if ethoxyethoxy ethanol is removed by hemodialysis or hemoperfusion. Hemodialysis should be considered in patients with severe metabolic acidosis or renal failure.

Range Of Toxicity

Summary

    A) TOXICITY: Based on extrapolation from animal data, it has been suggested that 91 mL could be lethal in a 70 kg man. However, case report data demonstrated recovery in a patient who ingested 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg).

Minimum Lethal Exposure

    A) ACUTE
    1) Based on extrapolation from animal data, it has been suggested that 91 mL could be lethal in a 70 kg man (Hanzlik et al, 1947).

Maximum Tolerated Exposure

    A) ROUTE OF EXPOSURE
    1) CASE REPORT: A 44-year-old man alcoholic ingested approximately 2 mL/kg (about 300 mL of a liquid containing 47% diethylene glycol monoethyl ether or 2000 mg/kg) and developed slight renal impairment with albuminuria, metabolic acidosis, cyanosis, and CNS and respiratory depression (Brennaas, 1960; Scientific Committee on Consumer Safety, 2013).
    2) Based on the Scientific Committee on Consumer Safety (SCCS), the following diethylene glycol monoethyl ether (DEGEE) concentrations do not pose a risk to the consumer (Scientific Committee on Consumer Safety, 2013):
    a) Up to 10% of DEGEE as a solvent in rinse-off cosmetic products.
    b) Up to 7% of DEGEE as a solvent in oxidative hair dye formulations.
    c) Up to 5% of DEGEE as a solvent in non-oxidative hair dye formulations.
    d) Up to 2.6% of DEGEE in all cosmetic products (including spray products, fine fragrances, hair sprays, and antiperspirants and deodorants).
    3) Based on the Scientific Committee on Consumer Safety (SCCS), DEGEE-containing products should only contain less than or equal to 0.1% of ethylene glycol. Products for oral hygiene and the eyes should not contain any DEGEE (Scientific Committee on Consumer Safety, 2013).

Workplace Standards

    A) ACGIH TLV Values for CAS111-90-0 (American Conference of Governmental Industrial Hygienists, 2010):
    1) Not Listed

    B) NIOSH REL and IDLH Values for CAS111-90-0 (National Institute for Occupational Safety and Health, 2007):
    1) Not Listed

    C) Carcinogenicity Ratings for CAS111-90-0 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed
    2) EPA (U.S. Environmental Protection Agency, 2011): Not Listed
    3) IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): Not Listed
    4) NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
    5) MAK (DFG, 2002): Not Listed
    6) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

    D) OSHA PEL Values for CAS111-90-0 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Not Listed

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) LD50- (INTRAPERITONEAL)MOUSE:
    1) 2300 mg/kg (RTECS , 2001a)
    B) LD50- (ORAL)MOUSE:
    1) 6600 mcL/kg (RTECS , 2001a)
    C) LD50- (SKIN)MOUSE:
    1) 6 mL/kg (RTECS , 2001a)
    D) LD50- (SUBCUTANEOUS)MOUSE:
    1) 5500 mcL/kg (RTECS , 2001a)
    E) LD50- (INTRAPERITONEAL)RAT:
    1) 360 mcg/kg (RTECS , 2001a)
    F) LD50- (ORAL)RAT:
    1) 5500 mcL/kg (RTECS , 2001a)
    G) LD50- (SKIN)RAT:
    1) 6 mL/kg (RTECS , 2001a)
    H) LD50- (SUBCUTANEOUS)RAT:
    1) 6000 mg/kg (RTECS , 2001a)

Physicochemical

Physical Characteristics

    A) This compound exists as a hygroscopic, colorless, slightly viscous liquid with a pleasant odor and bitter taste (Lewis, 2000; Budavari, 1996; Sax & Lewis, 1987; Clayton & Clayton, 1982)

Molecular Weight

    A) 134.17 (Budavari, 1996)

Animal Toxicology

Clinical Effects

    11.1.3) CANINE/DOG
    A) VOMITING - A single oral dose of 2 mL/kg of a 20% solution of ethoxyethoxy ethanol produced slight vomiting 3 hours after ingestion in a dog (Bingham et al, 2001).

References

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