See the latest advice on ethanol and toxic alcohols. How to manage withdrawals, the DTs and what is the right dose of thiamine anyway?

Quick Alcohol and Toxic alcohol Facts:
  • Rapid absorption
  • Small volume of distribution therefore amenable to dialysis
  • Metabolised in the liver to their various metabolites:
    • Ethanol to acetate
    • Isopropanol to acetone
    • Ethylene glycol to oxalate and glycolic acid
    • Methanol to formic acid
  • Distinguishing features:
    • Ethanol causes intoxication, mild lactic acidosis (rarely requires intubation)
    • Isopropanol – more potent than ethanol but similar clinical features 1ml/kg causes intoxication, >4ml/kg can cause coma and respiratory depression. Classically an elevated osmolar gap in the absence of a severe anion gap. Supportive care.
    • Ethylene glycol >1ml/kg is potentially lethal. An anion gap acidosis with elevated lactate +/- elevated osmolar gap, associated hypocalacaemia and rising creatine is pathognomonic of intoxication. The oxalate and glycolic acid cause renal failure. Calcium oxalate crystals maybe seen in the urine. Treatment is with ethanol/fomepazole and dialysis
    • Methanol >0.5 ml/kg of 100% is potentially lethal. Formic acid production leads to blindness, cerebral oedema and subcortical haemorrhages on CT. An anion gap acidosis, hyperlactataemia and an elevated osmolar gap are surrogate markers of intoxication. Treatment is with ethanol/fomepazole and dialysis.
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