Toxicology - Alcohols Flashcards
Metabolic Acidosis - High Anion Gap
methanol
uremia
DKA
paraldehyde
isoniazid
lactate
ethylene glycol
salicylates
Anion Gap - Formula
Na - (Cl + HCO3)
Toxic Alcohol Ingestion - Clinical Presentation
altered mental status (inebriation)
GI distress
Methanol - Presentation
early: GI distress / inebriation
later: high anion gap metabolic acidosis, visual changes
Ethylene Glycol - Presentation
early: GI distress / inebriation
later: high anion gap metabolic acidosis, nephrotoxicity, hypocalcemia
Methanol & Ethylene Glycol - Assessment
electrolytes & ABG
ethanol level
measured osmolality
Ethanol - Dose
1 g/kg
IV: 10% solution
PO: 4 shots
maintenance - BAC 100 mg/dL
Fomepizole - MoA
competitive inhibition of alcohol dehydrogenase
Fomepizole - Dose
15 mg/kg loading dose, then
10 mg/kg q12h x 4 doses, then
15 mg/kg q12h
diluted in NS/D5W, infused over 30 min
Ethanol - Adverse Effects
CNS inebriation, thrombophlebitis, GI symptoms
Fomepizole - Adverse Effects
headache
nausea
dizziness
minor allergic reactions
Sodium Bicarbonate - Uses
ethylene glycol - severe acidosis correction
methanol - acidosis correction, formic acid : formate ratio reduction
Hemodialysis - Indications
methanol or ethylene glycol level of 25-50 mg/dL
high osmol gap
end-organ manifestations of toxicity
severe metabolic acidosis
Osmol Gap - Formula
2 Na + BUN / 2.8 + Glucose / 18 + Alcohol / N,
where N is:
4.6 if ethanol
3.2 if methanol
6.2 if ethylene glycol
Methanol - Adjunctive Therapy
folic acid
