Isopropyl alcohol toxicity: Difference between revisions
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*Hypoglycemia (in malnourished pts) | *Hypoglycemia (in malnourished pts) | ||
== Work-Up == | == Differential Diagnosis == | ||
*[[Ethanol Toxicity]] | |||
*[[Methanol Toxicity]] | |||
*[[Ethylene Glycol Toxicity]] | |||
*Starvation ketoacidosis | |||
*[[Diabetic Ketoacidosis]] | |||
*Inborn errors of metabolism | |||
*[[Salicylate Toxicity]] | |||
*Acetone ingestion | |||
==Diagnosis== | |||
=== Work-Up === | |||
*Fingerstick glucose | *Fingerstick glucose | ||
*Complete metabolic panel | *Complete metabolic panel | ||
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*Total CK | *Total CK | ||
== | === 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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**Consider other diagnosis if absent 2hr after ingestion | **Consider other diagnosis if absent 2hr after ingestion | ||
*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== | ==Treatment== | ||
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*Hypotension | *Hypotension | ||
**Usually responsive to IVF; pressors may be necessary | **Usually responsive to IVF; pressors may be necessary | ||
*Hemodialysis | *Hemodialysis | ||
**Consider for: | **Consider for: | ||
***Hypotension refractory to conventional therapy | ***Hypotension refractory to conventional therapy | ||
***Isopropanol level >400 | ***Isopropanol level >400 | ||
===Contraindicated=== | |||
*Fomepizole | |||
**Metabolite, acetone, is no more toxic than the parent compound | |||
**Use may lead to prolonged CNS toxicity | |||
== Disposition == | == Disposition == | ||
*Consider | *Consider discharge if asymptomatic x 4-6hr | ||
== | == References == | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 01:47, 7 June 2015
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)
Differential Diagnosis
- Ethanol Toxicity
- Methanol Toxicity
- Ethylene Glycol Toxicity
- Starvation ketoacidosis
- Diabetic Ketoacidosis
- Inborn errors of metabolism
- Salicylate Toxicity
- Acetone ingestion
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
Treatment
- GI decontamination
- Activated charcoal ineffective (absorbed too quickly)
- Airway
- Mechanical ventilation may be necessary
- Hypotension
- Usually responsive to IVF; pressors may be necessary
- Hemodialysis
- Consider for:
- Hypotension refractory to conventional therapy
- Isopropanol level >400
- Consider for:
Contraindicated
- Fomepizole
- Metabolite, acetone, is no more toxic than the parent compound
- Use may lead to prolonged CNS toxicity
Disposition
- Consider discharge if asymptomatic x 4-6hr