Toxic Alcohol Ingestion

Last Updated on by frcemuser

Methanol and ethylene glycol

  • Both can cause metabolic acidosis, and both are treated in a similar way

Methanol

  • Methanol is the simplest alcohol
  • Contained in methylated spirits
  • Similar smell to ethanol
  • Converted to formic acid, which is not easily excreted by the body
  • This is highly toxic to the optic nerve causing blindness
  • Formic acid also interferes with aerobic metabolism causing a metabolic acidosis
  • Initially causes mild intoxication similar to the effect of ethanol CNS depressant like ethanol
  • Toxicity develops over hours due to metabolism to formic acid
  • Visual impairment and acidosis. the patient may have tachypnoea and dilated pupils
  • Treatment – Latent period provides an opportunity for treatment
    • Alcohol dehydrogenase inhibited by ethanol or fomepizole
  • Permanent blindness

Ethylene glycol

  • Widely used in industry, best known in antifreeze
  • Sweet taste makes it attractive to child ren
  • Converted to glycolic acid, and subsequently to oxalic acid
  • Oxalic acid binds to calcium and precipitates as crystals in many body tissues
  • Crystal formation in the kidneys can lead to renal failure
  • Stages
  • First stage, up to 12 hours: Similar to alcohol intoxication, slurred speech, incoordination, confusion, nausea and vomiting.
  • The second stage, 12 to 36 hours: Metabolic acidosis, tachycardia, hyperventilation. Most deaths occur in this stage.
  • The third stage, 1 to 3 days: Renal failure.
  • Treatment :
    • Alcohol dehydrogenase inhibited by ethanol or fomepizole
    • Renal failure may require dialysis.
  • Survivors make a full recovery

ABG:

  • High osmolar gap > 10
  • High anion gap metabolic acidosis
  • Normal blood alcohol level

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