Alcohol Toxidrome
AGENTS
- ethanol
- methanol
- ethylene glycol
- isopropyl alcohol
- others!
CLINICAL FEATURES
- euphoria
- disinhibition
- stupour
- respiratory depression
- cardiovascular depression
- coma
- ocular toxicity = methanol
- hypocalcemia + renal failure = ethylene glycol
- haemorrhagic gastriyis = isopropyl alcohol
INVESTIGATIONS
- ethanol level (> 400mg/dL -> coma and respiratory depression)
- ethylene glycol level (severe lactic acidosis)
- high osmolar gap then HAGMA
- electrolyte abnormalities
SPECIFIC MANAGEMENT AND TRIGGERS FOR INTERVENTION
Ethanol
- thiamine (50-100mg) then dextrose
- hydration
- supportive
- replace electrolytes
Methanol
- decreased production of toxic metabolites:
-> ethanol (competitive inhibitor to alcohol dehydrogenase)
-> 4-methylapyrazole (same as ethanol but easier to titrate and no sedative effects – not available in Australasia)
-> sodium bicarbonate (undissociated formic acid more toxic than the dissociated product – give if pH < 7.3) -> folinic acid: 50mg Q4hrly (decreases formate levels and decreases toxicity)
- increase elimination:
-> haemodialysis: effectively and rapidly removed including toxic metabolites
Ethylene Glycol
- decrease production of toxic metabolites: ethanol or 4-methylpyrazole (not available in Australiasia)
-> ethanol dose (IV): 10% solution in D5W as a 40% solution, loading dose 7.5mL/kg -> 1-2mL/kg/hr
-> ethanol dose (PO): quarter the above dose
-> dose in CRRT: double IV dose
-> maintain ethanol level @ 25-40mmol/L
- haemodialysis
- thamine 100mg IV Q6 hrly – theoretical benefit to increase elimination
- pyridoxine (vitamin B6) 50mg IV Q6hrly – theoretical benefit to increase elimination
- don’t replace Ca2+ unless low enough to cause manifestations
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC