Isopropyl alcohol toxicity: Difference between revisions

No edit summary
Line 53: Line 53:


== Source ==
== Source ==
Uptodate
*Uptodate
*Rosen


Rosen
[[Category:Tox]]

Revision as of 11:07, 19 December 2011

Background

  • Isopropyl alcohol acts directly as CNS depressant and is broken down by alcohol dehydrogenase to acetone, which further compounds effect
  • Lethal Dose: 4-8 g/kg or 250mL in average adult

Clinical Features

  • Symptoms of inebriation, disinhibition, sedation, and coma usually peak in the first hour of ingestion
  • "Fruity breath" can be seen as a result of acetone production

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

Diagnosis

  • Positive serum isopropyl alcohol level (if available)
  • 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 2 hours after ingestion
  • Elevated creatinine may be falsely elevated as a result of acetone interference with laboratory measurement of creatinine

DDX

  • Ethanol ingestion
  • Methanol or ethylene glycol ingestion
  • Starvation ketoacidosis
  • Diabetic ketoacidosis
  • Inborn errors of metabolism
  • Salicylate ingestion
  • Acetone ingestion

Treatment

  • Airway
  • Breathing
    • Consider intubation to secure airway
  • Circulation
    • Fluid rehydration
  • Minimal role in GI decontamination due to rapid absorption
    • May consider nasogastric aspiration if done within 1 hour of ingestion
  • Hemodialysis should be considered in persistently hypotensive patient after aggressive fluid hydration and vasopressor support or for Siopropyl levels greater than 400 mg/dL

Disposition

  • Unintentional ingestions may be safely discharged if asymptomatic after 2 hours of observation
  • Any intentional ingestions should be screened for suicidal ideation and alcohol addiction

Source

  • Uptodate
  • Rosen