Isopropyl alcohol toxicity

Revision as of 17:19, 21 February 2012 by Jswartz (talk | contribs)

Background

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

  • CNS depression
    • Similar to ETOH intoxication, but longer-lasting
    • Usually peak in first hour of ingestion
  • GI
    • N/V / abd pain / hemorrhagic gastritis
  • Respiratory depression
  • Hypotension
  • Hypoglycemia (in malnourished pts)

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

  • 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

DDX

Treatment

  • GI decontamination
    • Activated charcoal ineffective (absorbed too quickly)
  • Airway
    • Mechanical ventilation may be necessary
  • Hypotension
    • Usually responsive to IVF; pressors may be necessary
  • Fomepizole
    • Unnecessary
      • Metabolite, acetone, is no more toxic than the parent compound
      • Use may lead to prolonged CNS toxicity
  • Hemodialysis
    • Consider for:
      • Hypotension refractory to conventional therapy
      • Isopropanol level >400

Disposition

  • Consider d/c if asymptomatic x4-6hr

Source

  • Uptodate
  • Rosen
  • Tintinalli