Table 9.

Recommendations for treatment of toxic alcohol ingestionsa

DisorderTreatmentb
Methanol intoxicationInitiate fomepizole (alcohol if fomepizole not available) and HD with methanol >20 mg/dl, in presence of HAGA with osmolal gap and high suspicion of ingestion. Initiate HD alone if HAGA present and methanol levels <10 mg/dl or no osmolal gap but strong suspicion of ingestion. Give folinic or folic acid. Give base with severe acidosis if patient not undergoing HD. Discontinue treatment when pH normalized and methanol levels <10 to 15 mg/dl or undetectable. If measurement of methanol not available use return of blood pH and serum osmolality to normal as goals of therapy.
Ethylene glycol intoxicationInitiate fomepizole (alcohol if fomepizole not available) and HD with ethylene glycol levels >20 mg/dl or in presence of HAGA with osmolal gap and high suspicion of ingestion. Initiate HD alone if HAGA present and ethylene glycol level <10 mg/dl or no osmolal gap but strong suspicion of ingestion. Give base with severe acidosis if patient not undergoing HD. Give thiamine and pyridoxine. Discontinue treatment when pH normalized and ethylene glycol levels <10 to 15 mg/dl or undetectable. If measurement of ethylene glycol not available use return of blood pH and serum osmolality to normal as goals of therapy.
Diethylene glycol intoxicationInitiate HD with osmolal gap, HAGA, and ARF or with high suspicion of ingestion because of cohort of cases ingesting contaminated medication. Administration of fomepizole not approved but recommended in addition to dialysis. Discontinuation of treatment with recovery of renal function, normalization of acid-base parameters and osmolal gap.
Propylene glycol intoxicationDiscontinue medication containing propylene glycol which will be effective alone in most cases. Initiate dialysis and/or fomepizole with severe LA or very high serum concentrations >400 mg/dl and evidence of severe clinical abnormalities.
Isopropanol intoxicationSupportive therapy usually sufficient. Initiate HD with serum level 200 to 400 mg/dl or in presence of marked hypotension or coma.c
Alcoholic ketoacidosisAdminister intravenous fluids including dextrose and NaCl; base rarely needed, might be considered with blood pH <6.9 to 7.0; consider administering insulin with marked hyperglycemia
  • a ARF, acute renal failure; HAGA, high anion gap metabolic acidosis; HD, hemodialysis; LA, lactic acidosis.

  • b Indications for treatment may differ from those of the American Academy of Clinical Toxicology particularly with recommendation for early initiation of HD (see text).

  • c Estimate of serum level to initiate HD not established.