{"id":5386,"date":"2011-07-14T20:26:02","date_gmt":"2011-07-14T20:26:02","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5386.htm\/"},"modified":"2015-05-26T17:04:11","modified_gmt":"2015-05-26T21:04:11","slug":"toxic-alcohols","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/toxic-alcohols.htm\/","title":{"rendered":"Toxic Alcohols"},"content":{"rendered":"
Plasma osmolality = (Na + K + Cl + lactate + glucose (convert) + urea + HCO3 + 6.5) x 0.985 (Inten Care Med 2013;39:302)<\/p>\n
Positive osmal gap >10 (2 Na + Gluc\/18 + BUN\/2.8 + ETOH\/3.7) ETOH\/4.6, Ethylene Glycol\/6.2, Methanol\/3.2, Isopropanol\/6.0, Propylene Glycol\/7.6 (Ann Emerg Med 1996;27) Also Acetone can cause osmal gap. Normal gap is considered <10, but ranges from -14 to 10, so a pt with a low baseline can be toxic with a gap less than 10 (this is crucial, a negative osmal gap does not rule out toxic etoh ingestion) \u00a0 Causes of high osmal gap <\/strong> ME DIE<\/strong> M<\/strong>ethanol E<\/strong>thylene glycol D<\/strong>iuretics (osmotic diuretics like mannitol) I<\/strong>sopropyl alcohol E<\/strong>thanol \u00a0 also:<\/strong> renal failure sepsis mannitol hyperlipidemia hyperproteinemia Propylene Glycol \u00a0 \u00a0 The authors correctly ascribe hyponatremia in these two cases to a physiologic shift of intracellular water to the extracellular volume in response to the osmotic pressure gradient imposed by hyperglycemia. Consequently, the osmolality of serum is somewhat dampened and the sodium concentration is decreased. It is commonly accepted that the serum sodium concentration decreases approximately 1.6 mmol\/L for each 100 mg\/dL increase in glucose above a nominal value of 100 mg\/dL (2). However, a value of 2.4 mmol\/L decrease in sodium per 100 mg\/dL increase in glucose may be more appropriate (3). Moreover, the authors accurately state that sodium measurements in such cases are true and reflect the physiologic dilutional effect of the hyperosmolality. Our data confirm analytical accuracy (\u00b1 1 mmol\/L) for sodium at glucose concentrations up to 2500 mg\/dL (unpublished data). In contrast, falsely low sodium values (pseudohyponatremia) may result from the volume exclusion effect due to very elevated triglycerides or protein when sodium is measured by indirect methods (those requiring a dilution step) but not when measured by direct (no dilution) methods (4). 3 T.A. Hillier, R.D. Abbott and E.J. Barett, Hyponatremia: evaluating the correction factor for hyperglycemia, Am J Med<\/em> 106<\/strong> (1999), p. 399.<\/p>\n Twice the CNS depressant as ETOH Metabolized to Acetone (ketone but not a ketoacid) Ketosis s acidosis Gastrointestinal symptoms are<\/p>\n prominent, including nausea, vomiting, hematemesis, and abdominal pain Acetone levels interfere with accurate Cr Just supportive care can d\/c 2 hours after return to baseline \u00a0 \u00a0 DID YOU KNOW THAT\u0085 isopropyl alcohol ingestion can falsely elevate the serum creatinine? There have been reports of \u0093pseudo\u0094-renal failure in patients who ingest isopropyl alcohol. A false elevation in serum creatinine can occur due to acetone interfering with the creatinine colorimetric assay. Using an enzymatic assay, such as that used in a blood gas analyzer, instead of the colorimetric assay will avoid the acetone interference and give a rapid and accurate measure of the patient\u0092s serum creatinine. \u00a0 If pt has an ETOH level >100 mg\/dl and they look sick it is prob not from toxic alcohol unless they somehow took a bunch of toxic alcohol, waited for metabolism and then drank etoh. Tox alcohol patients will also get sicker on rechecks<\/p>\n Isopropyl will cause an osmal gap. It fits into the formula if you divide isopropyl in mg\/dl by 6<\/p>\n Metab by alcohol dehyrog to formaldehyde then aldehyde dehydrog takes it to formic acid Blocks oxidative phosphorylation so you get lactic acidosis, can be severe Presents with abd pain and vision changes (snowfield vision)<\/p>\n Causes blindness, brain hemorrhage and GI c\/o<\/p>\n Give Folate b\/c it is a cofactor in the reduction of formic acid to CO2\u00a0 Get Methanol Levels<\/p>\n ethanol to maintain 100-150 or fomepizole<\/p>\n folate Patients with levels >0.5 g\/l should probably be dialyzed even with fomepizole treatment Review (Intensive Care Med 2005;31:189)<\/p>\n<\/span>Isopropyl (Rubbing, etc.)<\/span><\/h3>\n
<\/span>Methanol (Wood, printers, painters, antifreeze, windshield)<\/span><\/h2>\n