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Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management

Jeffrey A. Kraut and Ira Kurtz
CJASN January 2008, 3 (1) 208-225; DOI: https://doi.org/10.2215/CJN.03220807
Jeffrey A. Kraut
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Ira Kurtz
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Abstract

Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.

  • Copyright © 2008 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology
Vol. 3, Issue 1
January 2008
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Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management
Jeffrey A. Kraut, Ira Kurtz
CJASN Jan 2008, 3 (1) 208-225; DOI: 10.2215/CJN.03220807

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Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management
Jeffrey A. Kraut, Ira Kurtz
CJASN Jan 2008, 3 (1) 208-225; DOI: 10.2215/CJN.03220807
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  • Article
    • Abstract
    • Effect of Alcohols on Serum Osmolality and the Osmolal Gap
    • Absorption, Distribution, Metabolism, and Elimination from the Body
    • General Principles of Treatment
    • Methanol Intoxication
    • Ethylene Glycol Intoxication
    • Diethylene Glycol Intoxication
    • Propylene Glycol
    • Alcoholic Ketoacidosis
    • Isopropanol
    • Conclusions and Future Considerations
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
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