Toxic Alcohol Poisoning - Toxicology

Question 1

What are the 3 main toxic alcohols?

Answer 1

Ethylene glycol (antifreeze)
Methanol (windshield wiper fluid, de-icers, paint remover)
Isopropanol (rubbing alcohol, hand sanitizer)

Question 2

Toxic alcohol poisoning may present with severe acidosis (ethylene glycol & methanol, not isopropyl alcohol), if pH is <6.9 what should be administered?

Answer 2

Sodium bicarbonate 1-2 mEq/kg q 5 min prn

Question 3

What is the first line therapy in suspected toxic alcohol poisoning/unexplained acidosis/elevated anion gap/osmolar gap?

Answer 3

Fomepizole (Antizol)
First dose: 15 mg/kg over 30 min (max dose of 1g in 100mL)
2nd dose: 10 mg/kg (max 1g) q 12 hrs total max dose of 55 mg/kg

Question 4

After Fomepizole admin with an ethylene glycol/unk. toxic alcohol ingestion what’s the second line medication/vitamin to patch for? What’s the other vitamin to get on board?

Answer 4

Pyridoxine (vit B6) 1 mg/kg max dose of 50 mg q 6hrs
Thiamine (vit B1) 1 mg/kg max dose of 50mg q 8hrs
Both are co-factors in metabolism of ethylene glycol to non-toxic metabolites

Question 5

In toxic alcohol poisonings which acid should be administered regardless of the type of toxic alcohol?

Answer 5

Folic acid 1 mg/kg, max dose of 50 mg q4hrs
Note: folic acid decreases metabolic acidosis by decreasing formate (metabolizes formic acid) and decreasing loss of blood bicarb