(PO-079) An Unusual Case of Propylene Glycol Toxicity in a Patient with Amylophagia
Pica is commonly defined as a persistent eating of non-nutritional substance, and amylophagia is a subcategory of pica which involves the consumption of raw starch often in the form of laundry or corn starch (Feldman 1986). We illustrate a case in which a patient with long history of amylophagia since childhood who presented in a critically ill state with substantial electrolyte derangements, acid-base imbalance, and organ dysfunction.
Ms X is a 29 year-old African American female with a history of iron deficiency anemia, alcohol use disorder, and chronic amylophagia since childhood who presented as a transfer from an outside hospital for evaluation and management of hypotension, acute kidney and liver injury. On transfer, she had severe metabolic acidosis as well as multiple lab abnormalities. She was admitted to the medical ICU. Toxicology evaluation noted that while corn starch contains only small quantities of propylene glycol, ingestion of massive amounts of corn starch in addition to decreased clearance from an acute kidney injury (due to another cause) could have led to the acute toxicity in setting of chronic consumption. Our evaluation revealed that patient’s pattern of corn starch ingestion arose since childhood and her craving for corn starch strongly correlated with the degree of stress in her life. She noted that in the recent COVID lockdown and the ensuing unemployment, she had been consuming far more corn starch (16oz every 1-2 days) in the previous few months. She told us that she was surprised that eating corn starch could have caused her such devastating medical problems and wanted help to quit. Later in the hospitalization, patient developed persistent hypotension, acute respiratory failure, and epigastric pain, revealing a diffuse ischemic bowel with intraperitoneal hemorrhage. Palliative care was consulted, and her family decided on compassionate extubation.
This case highlights an unusual and lethal overdose of propylene glycol due to buildup from chronic amylophagia in combination with comorbid acute organ injuries. This is to our knowledge the first propylene glycol toxicity due to high volume corn starch ingestion. Our patient has multiple risk factors for pica including iron deficiency anemia (Borgna-Pignatti 2016). Recent increased psychosocial stress is also highly associated with increased intake of non-food items resulting in the cravings and maladaptive coping as described by our patient (Singhi 1981).
Clinicians should be aware that patients with pica could increase their non-food consumption during times of increased stress which could potentially lead to devastating medical consequences.
Borgna-Pignatti, C., Zanella, S. Pica as a manifestation of iron deficiency. Expert Review of Hematology. 2016;9(11):1075-1080
Feldman, M. Pica: Current Perspectives. Psychosomatics. 1986;27(7):519-523
Singhi, S., Singhi, P., Adwani, G. Role of Psychosocial Stress in the Cause of Pica. Clinical Pediatrics. 1981;20(12):783-785
Describe the biological, psychosocial, and cultural contributors to the development of pica.
Recognize common presenting symptoms of propylene glycol toxicity.
Explain the connection between amylophagia and propylene glycol toxicity.