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HWN Suggests

Toxic Alcohols – Minding the Gaps

Think of isopropyl alcohol poisoning as ethanol on steroids

Isopropyl alcohol, while technically is not a toxic alcohol, can cause morbidity and mortality and is more commonly ingested than the toxic alcohols. Isopropyl alcohol poisoning presents similarly to ethanol poisoning only more severely with coma and cerebellar signs, and it has more of a predilection for hemorrhagic gastritis and pancreatitis.

Don’t ignore abdominal complaints in patients with a history of alcohol misuse! Isopropyl alcohol is about twice as inebriating as is ethanol (for any particular load or blood level) and lasts twice as long.

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Articles of Interest

Hand Sanitizers: Keep Children Safe from Poisoning Risk

Many hand sanitizers are made with alcohol or rubbing alcohol (ethanol, ethyl alcohol, or isopropanol, isopropyl alcohol). Alcohol poisoning symptoms include loss of balance, sleepiness, low blood sugar, seizures and coma, and it can be fatal. Children and adults also have been poisoned after using hand sanitizer that contained methanol (also called wood alcohol, methyl alcohol, or methylated spirits).

MKSAP: 32-year-old man is disoriented, combative, and agitated

Isopropyl alcohol poisoning is characterized by an increased osmolal gap in the setting of positive serum and urine ketones and does not cause metabolic acidosis.

Paucis Verbis: Toxic alcohols – Isopropyl alcohol

In this toxic alcohol, fomipezole is actually NOT indicated because you want to have alcohol dehydrogenase convert the toxic parent compound (isopropyl alcohol) into the nontoxic metabolite (acetone).

The Dangers of Isopropyl Alcohol

Isopropyl alcohol can enter the body three ways: ingestion, inhalation, and absorption. The first way is most direct, and easiest to avoid. Since ingesting IPA causes rapid intoxication, people sometimes drink it when conventional alcohol is unavailable, or as a means of suicide. ingesting isopropyl alcohol has an immediate effect on the central nervous system,

The Unhappy Drunk: Toxic Alcohols

Isopropanol is the most commonly ingested toxic alcohol in the United States. Isopropyl alcohol is found in solvents and disinfectants. It is also found in mouthwashes, lotions, as well as rubbing alcohol and hand sanitizers. It is also hepatically metabolized by alcohol dehydrogenase to acetone. The acetone does not undergo further metabolism, and no acid byproducts are formed. This means that isopropanol is the only toxic alcohol that does not cause an elevated anion gap acidosis. It can cause hemorrhagic gastritis and profound inebriation with cerebellar signs and coma. Due to the acetone byproduct, the patient will sometimes have a fruity odor on their breath..

Toxic Alcohols

Found in hand sanitizers and disinfectants, isopropyl alcohol is a less common source of alcohol poisoning. The parent molecule does exhibit toxic effects here, unlike methanol and ethylene glycol. If untreated, the lethal dose is between 4-8 g/kg. Alcohol dehydrogenase metabolizes isopropyl alcohol into acetone. Because acetone is a ketone, and ketones are not oxidized into carboxylic acids, isopropyl alcohol poisoning does not result in anion gap metabolic acidosis.

Resources

StatPearls

Isopropanol, or isopropyl alcohol, is a clear, colorless liquid that emits an odor that resembles acetone. It is a commercially available product that mainly is found as a 70% solution in rubbing alcohol and hand sanitizers. Unlike the other toxic alcohols, isopropanol rarely causes death and is associated with ketosis without acidosis.

WikEM

Typical store bought rubbing alcohol is 70% isopropyl alcohol by volume, so lethal dose is ~ 350 mL