Toxic Alchols

Question 1

Ethanol

Answer 1

• 10g = 375 3.5% Beer, 1 wine , 30ml shot
• CNS and CVS depressant
• impair gluconeogenesis (NADH inhibit LAC-> pyr)
• >400mg/dl - Coma, RS dep, BP
• Look for other causes - metabolic, trauma , co-ingestion

Question 2

Ethylene Glycol

Answer 2

• Radiator coolant, anti freeze, brake fluid
• > 1ml/kg (1g/Kg) is LETHAL
• Glycolic acid , lactate
• Calcium Oxalate crys - kidney, heart, muscle, brain
• CNS> Cardiopulm> Renal (4-12 h)
• HAGMA, Osm gap, hypo Ca, AKI
• Resus :
  
  • hyperventilate, NaHCO3
  • Correct BSL, hyper K , hypo Mg, Ca (only if fits)
  • AD - Ethanol / Fomepizole
• HD if ;
  
  • OG>10, pH < 7.3, AKI, EG > 50mg/dL
• If co-ingested Ethanol - DELAYED signs

Question 3

Isoprophyl Alchol

AKA Isopropanol - sanitizers, disinfectants

Answer 3

• Dose related CNS dep like Ethanol ( oral /dermal)
• Acetone
• high OG but No HAGMA, +ve KETONES
• HD - rearely needed

Question 4

Methanol

AKA Methyl alchol

• Carburettor cleaning fluid
• Thinners / varnish / paints
• Dyes and stains
• Fuel additive, racing car fuel
• Wood spirits
• Home distilled spirits

Answer 4

• > 0.5 ml/kg is LETHAL (2.5ml in toddler !)
• Formic acid , Lactate
  
  • Retinal injury and odema - blurring > BLINDNESS
  • Subcortical WM heammorages - CNS symptoms
• HAGMA, OG , high Lactate
• RESUS -
  
  • hyperventilate, NaHCO3
  • AD - Ethanol , Fomepizole , Folinic acid
• HD ;
  
  • if ADH blocked, pH<7.3, visual symp, AKI, Methanol > 50mg/dL
• Ethanol can DELAY symptoms