Alcohol Toxicity


Type of Alcohol Symptoms Treatment
EtOH Toxicity
  • Decr. mental status, resp. depression, ataxia, slurred speech, nystagmus
  • N/V, hypothermia, incoordination, sleepiness (children)

 

  • Antidote ("coma cocktail:" decr. mental status)
    • D50W 25-50 g IV (peds: 1 mL/kg diluted 1:1 IV)
    • Thiamine 50-100 mg IV
    • Naloxone 2mg IV (peds <5 yo: 0.1 mg/kg IV)
  • Consider NGT placement: esp. large ingestions, pediatrics
  • Hemodialysis: useful for severely elevated EtOH levels
  • Dextrose 25 g IV (peds: 0.5-1 g/kg)
Ethylene Glycol Toxicity
  • Anti-freeze
  • Nystagmus, tachycardia, hypotension
  • Coma, depressed mental status without smell of ethanol
  • Ca Oxalate Stones in urine
  • Antidotes
    • 4-methylpyrazole IV (fomepizole, Antizol) (preferred)
      • Load: 15 mg/kg IV
    • Ethanol
      • Load: 750 mg/kg IV (7.5 mL/kg of 10% ethanol in D5W)
  • Thiamine: 100 mg IV
  • Pyridoxine: 100 mg IV
  • NaHCO3: 1-2 mEq/kg [1-2 mmol/kg] IV if pH < 7.25 and
  • Consult with nephrology for consideration of hemodialysis
Methanol toxicity
  • History of ingestion (may be unreliable)
    • Windshield wiper fluid, wood alcohol, solvents
  • CNS: headache, vertigo, confusion, seizures
  • Visual changes: blurred vision, defects in color vision, "snowfield vision", total blindness
  • GI: nausea/vomiting, abdominal pain
  • Antidotes
    • 4-methylpyrazole (fomepizole, Antizol) IV
      • Loading dose: 15 mg/kg, then 10 mg/kg q12hrs
    • Ethanol
      • Load IV with 7.5 mL/kg of 10% ethanol in D5W over 20-60 min as tolerated
      • IV ethanol infusions may be associated with
        • Hypotension
        • Electrolyte abnormalities
        • Hypoglycemia
        • Inebriation
  • Augment elimination
    • Folate (1 mg/kg IV q4hr) and leucovorin (1 mg/kg IV up to 50 mg)
      • May enhance clearance of formate
      • Reasonable adjunctive therapies following ADH blockade
Isopropanol toxicity
  • History of: rubbing alcohol ingestion, skin, or inhalation exposure
  • Small ingestion: CNS sedation, ataxia, stupor, GI bleed, severe gastritis, N/V
  • Large ingestion: hypotension, respiratory arrest
    • Onset: 30-60 min; duration: up to 24 hr
  • Decrease absorption
    • Gastric lavage <2 hr from ingestion (60 min according to POISINDEX)
    • Activated charcoal: use if suspect coingestion
      • 1 g charcoal absorbs 1 mL of 70% isopropanol
      • POISINDEX: 100 g/mL to get 20:1 ratio
  • Increase elimination
    • Hemodialysis: shock, level>400 mg/dL [66 mmol/L]
    • Ethanol IV NOT indicated
  • Hypotension
    • IVF, vasopressors: norepinephrine, dopamine