Isopropanol toxicity

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Summary

Definition

  • Also known as isopropyl alcohol, or rubbing alcohol

Pathophysiology

  • The alcohol is metabolized by alcohol dehydrogenase to acetone, causing ketosis and an osmolar gap, but not an elevated anion gap

Clinical Manifestations

  • CNS depression
  • Acetone-fruity breath
  • Shock, pulmonary edema, hemorrhagic tracheobronchitis

Investigations

  • Glucose, to rule out hypoglycemia as a cause of CNS depression
  • Acetaminophen and aspirin levels for coingestion
  • ECG for QTc
  • Osmolar gap, will be high
  • Electrolytes, creatinine, urea
    • Urea measures as elevated with isopropyl alcohol
  • Serum isopropyl alcohol and acetone levels

Management

  • ABCs, supportive care
  • No role for fomepizole or ethanol