toxic alcohols

Question 1

3 reason for substance fatality

Answer 1

Alcohols: methanol, ethylene glycol, isopropanol

Question 2

How to calculate anion gap

Answer 2

Gap= Na - (Cl + HCO3)

Question 3

Causes of high anion gap (metabolic acidosis) MUDPILES

Answer 3

• Methanol
• Uremia
• DKA/SKA/AKA
• Phenformin (metformin), Paraldehyde
• Isoniazid, iNH
• Lactate, CO, CN, Methb
• Ethylene Glycol
• Salicylates

Question 4

Clinical presentation of alcohol toxicity

Answer 4

• AMS/ inebriation
• GI distress

Question 5

what should be supplemented with Methanol induced toxicity

Answer 5

Folic acid

Question 6

What products have methanol

Answer 6

• gas line antifreeze, windshield washer fluid, denaturants

Question 7

Which products have ethylene glycol

Answer 7

• automobile coolant, solvents, de-icers, air conditioning units

Question 8

what should be supplemented with Ethylene glycol induced toxicity

Answer 8

thiamine, pyridoxine (B6), and Mag

Question 9

Treatment for alcohol induced toxicity

Answer 9

• 1st line: Fomepizole
• OR ethanol
• Na bicard until acidosis corrected
• consider Hemodialysis

Question 10

What can we use fir decontaimination in alcohol induced toxicity

Answer 10

Not useful

Question 11

Fomepizole dosing

Answer 11

load 15 mg/kg, then 10 mg/kg, then maintenance 15 mg/kg Q12hrs

Question 12

Ethanol dose

Answer 12

1 g/kg IV 10% solution or 4 shots
- maintain BAC ~ 100 mg/dL

Question 13

When to give hemodialysis to patients with alcohol toxicity

Answer 13

• levels 25-50 mg/dl
• high osmol gap w/ no cause
• end organ toxicity
• severe metabolic acidosis

Question 14

Pros/ cons of Fomepizole

Answer 14

• easy to use
• minimal AE
• expensive

Question 15

Pros/cons of ethanol

Answer 15

• inexpensive
• difficult to dose/titrate/ prep
• AE: inebriation, thrombophlebitis, Gi symptoms
• availability