Isopropanol Toxicity

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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

Clinical Features

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

Diagnosis

  • Ketonuria/ketonemia
  • No acidosis
  • Elevated osmolar gap

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

  • Tintinalli
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