Ethanol

Competitively blocks the formation of toxic metabolites in toxic alcohol ingestion by having a higher affinity for the enzyme Alcohol Dehydrogenase (ADH). Its chief application is in methanol and ethylene glycol ingestion, although it has been used with other toxic alcohols. Ethanol is now regarded as the second choice antidote in those countries with access to the specific ADH blocker, fomepizole.

Administration

Ethanol can be administered by the oral, nasogastric or intravenous route to maintain a blood ethanol concentration of 100-150 mg/dl (22-33 mol/L)

Oral or Nasogastric:

• Loading dose = 1.8 ml/kg of 43% ethanol, or 3 x 40ml shots of vodka in a 70 Kg adult. (No need to load if already under the influence!
• Maintenance = 0.2 – 0.4 ml/kg/hour of 43% ethanol, or 40ml shot each hour.

Intravenous:

• Loading dose = 8 ml/kg of 10% ethanol
• Maintenance = 1-2 ml/kg/hour of 10% ethanol
• Depending on your institution the pharmacist will have to make this up otherwise is is made by adding 100ml of 100% ethanol to 900ml of 5% dextrose.

Remember:

• The maintenance dosing will vary for each patient.
• It can cause hypoglycaemia in the paediatric population therefore, monitor BSLs.
• Maintain ethanol therapy until the toxic alcohol has been definitively treated with haemodialysis

References

• Barceloux DG, Krenzelok EK, Olson K et al. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Journal of Toxicology – Clinical Toxicology 1999; 37(5):537-560.
• Lepik KJ, Levy AR, Sobolev BG et al.  Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Annals of Emergency Medicine 2009; 53:439-450.