Isopropyl alcohol toxicity

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