Table 8.

Epidemiology, diagnostic clues, poor prognostic factors, and recommendations for treatment of toxic alcohol ingestionsa

DisorderEpidemiologyDiagnostic CluesbPoor Prognostic Factors
Methanol intoxicationAccidental or intentional ingestion of adulterated alcohol or products with methanol; rare cases of inhalation of methanolOsmolal gap with HAGAcBlood pH <7.1; LA; severe coma; severe hypotension; serum methanol >50 to 100 mg/dl
Visual difficulties with optic papillitis
Ethylene glycol intoxicationAccidental or intentional ingestion of antifreeze, alcohol adulterated with ethylene glycol, or products with ethylene glycolOsmolal gap with HAGAcBlood pH <7.1; glycolate level >8 to 10 mmol/L; ARF requiring HD; diagnosis >10 h after ingestion; serum ethylene glycol >50 to 100 mg/dl
ARF with osmolal gap
Calcium oxalate crystals in urine, monohydrate or dihydrate
Diethylene glycol intoxicationIngestion of contaminated medication or products with diethylene glycolOsmolal gap with HAGAcBlood pH <7.1; ARF requiring HD; severe coma; ingestion of >1.34 mg/kg body wt
Osmolal gap with ARF
Osmolal gap with coma
Propylene glycol intoxicationIntravenous administration of medication with propylene glycol; rare ingestion of products with propylene glycolOsmolal gap with or without LASevere LA; serum propylene glycol level >400 to 500 mg/dl
Isopropanol intoxicationAccidental or intentional ingestion of rubbing alcoholOsmolal gap without HAGASevere LA; hypotension; serum isopropanol level ≥200 to 400 mg/dl
Alcoholic ketoacidosisBinge drinking often in alcoholic patients associated with starvation and often vomitingHAGA, trace positive or negative nitroprusside reaction with increase with H2O2; hypoglycemia; osmolal gapBlood pH <7.0; severe comorbid conditions
  • a ARF, acute renal failure; HAGA, high anion gap metabolic acidosis; HD, hemodialysis; LA, lactic acidosis.

  • b Clues present in descending order of usefulness.

  • c Presence of serum osmolal gap and HAGA will depend largely on time after ingestion when blood is sampled. Presence of osmolal gap and HAGA together are important diagnostic clues.