ethanol level (> 400mg/dL -> coma and respiratory depression)
ethylene glycol level (severe lactic acidosis)
high osmolar gap then HAGMA
SPECIFIC MANAGEMENT AND TRIGGERS FOR INTERVENTION
thiamine (50-100mg) then dextrose
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)
-> haemodialysis: effectively and rapidly removed including toxic metabolites
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
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
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.