Isopropyl alcohol toxicity: Difference between revisions
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**Metabolized to acetone, not to an acid | **Metabolized to acetone, not to an acid | ||
*Takes 30-60 min for acetone to appear in blood; 3 hr to appear in urine | *Takes 30-60 min for acetone to appear in blood; 3 hr to appear in urine | ||
*Lethal Dose: 4-8 g/kg or 250 mL in average adult | *Lethal Dose: 4-8 g/kg or 250 mL in average adult (calculated using volume of pure isopropyl alcohol) | ||
**Typical store bought rubbing alcohol is 70% isopropyl alcohol by volume, so lethal dose is ~ 350 mL | **Typical store bought rubbing alcohol is 70% isopropyl alcohol by volume, so lethal dose is ~ 350 mL | ||
Revision as of 02:03, 22 June 2016
Background
- Main component of rubbing alcohol
- Hallmark is osmolar gap without acidosis
- Metabolized to acetone, not to an acid
- Takes 30-60 min for acetone to appear in blood; 3 hr to appear in urine
- Lethal Dose: 4-8 g/kg or 250 mL in average adult (calculated using volume of pure isopropyl alcohol)
- Typical store bought rubbing alcohol is 70% isopropyl alcohol by volume, so lethal dose is ~ 350 mL
Clinical Features
- CNS depression
- Similar to ETOH intoxication, but longer-lasting
- Usually peaks in first hour of ingestion
- GI
- Nausea/vomiting / abdominal pain / hemorrhagic gastritis
- Respiratory depression
- Hypotension
- Hypoglycemia (in malnourished patients)
Differential Diagnosis
- Starvation ketoacidosis
- Diabetic Ketoacidosis
- Inborn errors of metabolism
- Salicylate Toxicity
- Acetone ingestion
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
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
Toxic Alcohols Anion/Osmolar Gaps
Osmolar gap | Anion gap | Management | |
---|---|---|---|
Ethanol | + | + if ketoacidosis | Mainly supportive |
Ethylene glycol | + | + | Fomepizole, Thiamine, Pyridoxine, +/- Dialysis |
Methanol | + | + | Fomepizole or ethanol, Folinic acid, +/- Dialysis |
Isopropyl alcohol | + | - | Mainly supportive |
Management
- Treatment is supportive.
- No role for fomepizole or ethanol
Disposition
- Generally may be discharged once clinically sober.