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7453 Neuro Test 4 > Toxic Alcohols > Flashcards

Toxic Alcohols Flashcards

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1
Q

Which alcohol is directly toxic?

A

isopropanol

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2
Q

Which comes first in alcohol metabolism alcohol dehydrogenase or aldehyde dehydrogenase?

A

alcohol dehydrogenase

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3
Q

Anion gap present if > __

A

12

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4
Q

Anion gap formula:

A

Na-Cl-HCO3

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5
Q

What is normal osmol gap?

A

10-20

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6
Q

osmolality formula?

A

(2 x Na) + (BUN/2.8) + (glucose/18) + (EtOH/4.6)

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7
Q

Ethanol competitively inhibits ___, which decreases the metabolism of toxic alcohols

A

alcohol dehydrogenase

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8
Q

Ethylene glycol is metabolized by alcohol dehydrogenase into __

A

glycoaldehyde

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9
Q

Ethylene glycol is metabolized by aldehyde dehydrogenase into ___.

A

glycolate > oxalate

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10
Q

Which alcohol is metabolized into formate?

A

methanol

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11
Q

Which alcohol is metabolized into acetone?

A

isopropanol

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12
Q

3 things associated with anion gap PLUS osmolar gap?

A
  • methanol
  • ethylene glycol toxicity
  • alcoholic ketoacidosis
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13
Q

Osmolar gap WITHOUT anion gap is associated with __ alcohol toxicity

A

isopropyl

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14
Q

Osmolar gap formula?

A

measured - calculated

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15
Q

__ is in antifreeze that makes it detectable in urine.

A

fluorescein

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16
Q

Ethylene glycol pea concentration is in __ to __ hours

A

1, 2

rapid GI absorption

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17
Q

Toxic ingestion of ethylene glycol is __ mL

A

100

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18
Q

What is the consensus guideline recommendation for ethylene glycol referral to healthcare facility?

A

children with more than an observed lick, sip, or taste intestine or adult with known accidental ingestion of more than a swallow (10-30mL) should be referred immediately

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19
Q

Concomitant __ ingestion will use up alcohol dehydrogenase and delay metabolism of ethylene glycol.

A

ethanol

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20
Q

Ethylene glycol is metabolized to glycoaldehyde by what enzyme?

A

alcohol dehydrogenase

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21
Q

Ethylene glycol is metabolized into ___ at the final step

A

oxalic acid

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22
Q

__ is needed to metabolize glyoxylic acid (ethylene glycol) into hippuric acid?

A

pyridoxine

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23
Q

___ and ___ are needed to metabolize glyoxylic acid (ethylene glycol) into alpha hydroxy beta ketoadapic acid?

A

thiamine, magnesium

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24
Q

ethylene glycol can cause ___ crystals to deposit in the kidneys, heart, and lungs

A

calcium oxalate

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25
Q

Which ethylene glycol effects happen in 30mins to 12 hours?

CNS
metabolic
renal

A

CNS

n/v, inebriation, seizures

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26
Q

Which ethylene glycol effects happen in 2-3 days

A

renal

calcium oxalate, ATN, hematuria/proteinuria

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27
Q

Which ethylene glycol effects happen in 12-24 hours?

A

metabolic

cardiopulmonary compromise, AG acidosis

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28
Q

consider nasogastric aspiration for ethylene glycol if less than ___ hour

A

1

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29
Q

Is activated charcoal effective for ethylene glycol?

A

no

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30
Q

Use hemodialysis if ethylene glycol > __mg/dL

A

100

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31
Q

What 3 things are used in ethylene glycol shunting therapy?

A
  • thiamine
  • magnesium
  • pyridoxine
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32
Q

2 ethylene glycol antidotes?

A
  • ethanol
  • fomepizole

alcohol dehydrogenase inhibition

33
Q

Use antidote if ethylene glycol level is > __ mg/dL

A

20

continue until < 20, AND acidosis is resolved

34
Q

The dose of ethanol as ethylene glycol antidote is __ gm/kg IV bolus, then __ mg/kg/hr infusion.

A

0.8, 130

35
Q

Fomepizole dose for ethylene glycol antidote?

A

15g/kg IV load followed by 10mg/kg Q12H x 4 doses

increase to 15mg/kg IV Q12

36
Q

Fomepizole does does not have to be adjusted in HD initiated.

a. true
b. false

A

b. false

37
Q

Which ethylene glycol antidote is done at ICU level care?

A

ethanol

38
Q

Which ethylene glycol antidote doe not need levels/monitoring?

A

fomepizole

39
Q

What is the only FDA approved ethylene glycol antidote?

A

fomepizole

ethanol not FDA approved

40
Q

___mL of methanol may be fatal?

A

15

41
Q

___mL/kg of methanol may be fatal?

A

0.25

42
Q

Methanol is metabolized to ___ acid.

A

formic

43
Q

Which alcohol causes visual complaints like blindness, “snow storm”, “seeing the wind”?

A

methanol

44
Q

Acidosis may be delayed with which alcohol?

A

methanol

45
Q

Methanol > __ mg/dL is indication for antidote therapy.

A

25

46
Q

What is used for methanol shunting therapy?

A

folic acid

to accelerate transformation from formic acid

47
Q

What is used for methanol adjunctive therapy?

A

bicarb therapy

increase pH and formic acid dissociation

48
Q

Hemodialysis is especially useful for methanol if level > __ mg/dL

A

45

49
Q

Which alcohol has no direct anion gap acidosis?

A

isopropyl

unless ketosis causes it

50
Q

Which alcohol has no antidote?

A

isopropanol

51
Q

Which CYP metabolizes ethanol?

A

2E1

52
Q

Which alcohol is partially metabolized by the peroxidase-catalase system?

A

ethanol

53
Q

Nasogastric aspiration is used with what alcohol?

A

ethanol

not activated charcoal

54
Q

Which alcohol is metabolized to acetyl CoA?

A

ethanol

ethanol > acetaldehyde > acetate > acetyl CoA

55
Q

Ethanol causes depletion of NAD+ or NADH?

A

NAD+

gluconeogenesis
pyruvate entering kreb’s cycle

56
Q

Ethanol causes accumulation of NAD+ or NADH?

A

NADH

pyruvate conversion to lactate
ketone formation

57
Q

What B vitamin is given for ethanol toxicity management?

A

B1 (thiamine)

“banana bag”

+/- magnesium

58
Q

What is unregulated in ethanol withdrawal?

A

glutamate

59
Q

Manifestations of ethanol withdrawal occur up to __ days.

A

10

60
Q

Which ethanol withdrawal Sx occur in 12-24hrs?

autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens

A

autonomic hyperactivity

61
Q

Which ethanol withdrawal Sx occur in 24-48hrs?

autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens

A

hallucinations, excitation

62
Q

Which ethanol withdrawal Sx occur in 48-96hrs?

autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens

A

delirium tremens

63
Q

What is very mild CIWA-Ar score?

A

0-9

Tx with thiamine/supportive care

64
Q

What is mild CIWA-Ar score?

A

10-15

Tx with thiamine and supportive care and lorazepam therapy

65
Q

What is moderate CIWA-Ar score?

A

> = 16

66
Q

What is severe CIWA-Ar score?

A

> = 21

67
Q

Does isopropanol have anion gap?

A

no

68
Q

Does methanol have anion gap?

A

yes

69
Q

Does ethylene glycol have anion gap?

A

yes

70
Q

Does ethanol have anion gap?

A

yes in AKA

71
Q

Does isopropanol cause ketosis?

A

yes

72
Q

Does methanol cause ketosis?

A

no

73
Q

Does ethylene glycol cause ketosis?

A

no

74
Q

Does ethanol cause ketosis?

A

yes in AKA

75
Q

What Sx is associated with isopropanol?

A

gastritis

76
Q

What Sx is associated with methanol?

A

blindness

77
Q

What Sx is associated with ethylene glycol?

A

renal failure

78
Q

What Sx is associated with ethanol?

A

hypoglycemia

7453 Neuro Test 4 (9 decks)

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