S61(2) - Toxic Alcohol Flashcards
Na = 141 Cl = 110 BUN = 19 glucose = 145 K = 3.6 Bicarb = 20 SCr - 1.6
calculate anion gap?
141-110-20 = 11
Na - Cl - bicarb = anion gap
true
2(Na+) + BUN/2.8 + Glucose/18 = olsmalality
true
2(Na+) + BUN/2.8 + Glucose/18 + EtOH/4.6 = = calculated osmolality
true
Osmolar gap = measured – calculated
true
A consensus guideline recommends that children with more than an observed lick, sip or taste ingestion or an adult with known accidental ingestion of more than a “swallow” (10 to 30 mL) should be referred immediately to a healthcare facility
true
Toxic ingestion: ~100mL
Toxic product of ethylene glycol is oxalic acid
true
oxalic acid can binds calcium to form calcium oxylate and forms crystals.
Deposits in lungs, heart, kidneys
Can cause cranial nerve damage
Co-ingestion of alcohol can delay damage
true
Ethylene toxicity phases:
Phase 1
30 mins-12 hours
CNS effects: N/V, inebriation, sz
Ethylene toxicity phases:
Phase 2
12-24 hour
Metabolic: cardiopulmonary compromise, Anion Gap acidosis
Ethylene toxicity phases:
Phase 3
2-3 days
Renal: calcium oxalate, Acute Tubular Necrosis, hematuria/proteinuria
Early management of ethylene toxicity:
Consider nasogastric aspiration (if less than 1 hour)
Activated charcoal NOT effective
Sodium bicarbonate only if life threatening acidosis
suction of contents
true
Ethylene glycol toxicity antedote:
Ethanol
Fomepizole
true
Alcohol dehydrogenase inhibition
Ethylene glycol toxicity Shunting therapy
Thiamine, magnesium, pyridoxine
true
“Shunting Therapy” utilizes:
A. 50mg of vitamins B1 and B6 IV q 6 hours
B. 100mg of vitamins B1 and B6 PO q 12 hours
C. 50mg of folic acid SQ injection
D. 100mg of vitamins B1 and B6 IV q 6 hours
A. 50mg of vitamins B1 and B6 IV q 6 hours
Antidotal Therapy Indications 1.) Ethylene glycol level > 20 mg/dL 2.)History of ingesting ethylene glycol with osmol gap > 10 mOsm/kg 3.) Clinical suspicion of ethylene glycol poisoning + two of the following: - pH < 7.3 (acidosis) - Bicarbonate < 20 mEq/L (acidosis) - Osmolar gap > 10 mOsm/kg - Urinary oxalate crystals
True
Continued until ethylene glycol < 20 mg/dL AND acidosis is resolved
Ethanol administration Caution for the following:
Phlebitis (central line preferred)
Hypoglycemia
Altered mentation
true
Fomepizole (FDA approved)
Alcohol dehydrogenase inhibitor
8000x higher affinity than ethanol
true
Dose MUST be adjusted if HD initiated
Ethylene glycol
Found in
antifreeze (95%), brake fluid, and solvents in industry
also adulterated spirits
true
What urgent treatment can we use, if any?
Hemodialysis
ethylene glycol > 100 mg/dL
refractory acidosis
renal failure
ethylene glycol
anion gap present
osmolar gap present
normal anion gap = <12
normal osmolar gam 10-20
