Isopropyl alcohol toxicity: Difference between revisions

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*Lethal Dose: 4-8 g/kg or 250mL in average adult
*Lethal Dose: 4-8 g/kg or 250mL in average adult


== Clinical Features ==
==Clinical Features==
*CNS depression
*CNS depression
**Similar to ETOH intoxication, but longer-lasting
**Similar to ETOH intoxication, but longer-lasting
**Usually peak in first hour of ingestion
**Usually peaks in first hour of ingestion
*GI
*GI
**[[Nausea/vomiting]] / [[abdominal pain]] / hemorrhagic gastritis
**[[Nausea/vomiting]] / [[abdominal pain]] / hemorrhagic gastritis
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*[[Hypoglycemia]] (in malnourished pts)
*[[Hypoglycemia]] (in malnourished pts)


== Differential Diagnosis ==
==Differential Diagnosis==
*[[Starvation ketoacidosis]]
*[[Starvation ketoacidosis]]
*[[Diabetic Ketoacidosis]]
*[[Diabetic Ketoacidosis]]
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==Diagnosis==
==Diagnosis==
=== Work-Up ===
===Work-Up===
*Fingerstick glucose
*Fingerstick glucose
*Complete metabolic panel
*Complete metabolic panel
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*Total CK
*Total CK


=== Evaluation ===
===Evaluation===
*Osmolal gap > 10; see [[Osmolal or Osmolar Gap]]
*Osmolal gap > 10; see [[Osmolal or Osmolar Gap]]
*Absence of anion gap
*Absence of anion gap
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*Creatinine may be falsely elevated d/t acetone interference w/ laboratory measurement of Cr
*Creatinine may be falsely elevated d/t acetone interference w/ laboratory measurement of Cr


==Treatment==
==Management==
*Mechanical ventilation may be necessary
*Treatment is supportive.
*Hypotension
**Usually responsive to IVF; pressors may be necessary
*Hemodialysis
**Consider for:
***Hypotension refractory to conventional therapy
***Isopropanol level >400


===Contraindicated===
==Disposition==
*Fomepizole
*Generally may be discharged once clinically sober.
**Metabolite, acetone, is no more toxic than the parent compound
**Use may lead to prolonged CNS toxicity
*GI decontamination
**Activated charcoal ineffective (absorbed too quickly)


== Disposition ==
==See Also==
*Consider discharge if asymptomatic x 4-6hr


== References ==
 
==References==
<references/>


[[Category:Tox]]
[[Category:Tox]]

Revision as of 04:38, 23 February 2016

Background

  • Main component of rubbing alcohol
  • Hallmark is osmolar gap without acidosis
    • Metabolized to acetone, not to an acid
  • Takes 30-60min for acetone to appear in blood; 3hr to appear in urine
  • Lethal Dose: 4-8 g/kg or 250mL in average adult

Clinical Features

Differential Diagnosis

Sedative/hypnotic toxicity

Diagnosis

Work-Up

  • Fingerstick glucose
  • Complete metabolic panel
  • Serum ketones
  • Serum Osmolality
  • Uinarlysis
  • VBG
  • Aspirin/Tylenol levels
  • ECG
  • Serum isopropyl alcohol level (if available)
  • Total CK

Evaluation

  • Osmolal gap > 10; see Osmolal or Osmolar Gap
  • Absence of anion gap
  • Absence of metabolic acidosis
  • Absence of serum beta hydroxybutyrate
  • Presence of serum and urine ketones
    • Consider other diagnosis if absent 2hr after ingestion
  • Creatinine may be falsely elevated d/t acetone interference w/ laboratory measurement of Cr

Management

  • Treatment is supportive.

Disposition

  • Generally may be discharged once clinically sober.

See Also

References