Rubbing alcohol toxicity

May 31, 2014, 10:08 am

isopropyl★★★½☆

Isopropanol poisoning. slaughter RJ et al. Clin Toxicol 2014 May 9 [Epub ahead of print]

Abstract

This comprehensive and well done review article will tell you perhaps more than you wanted to know about isopropyl alcohol poisoning.

This is, frankly, not the sexiest topic in medical toxicology, since isopropanol ingestion generally responds to supportive care and rarely causes death. However, for those who want to get granular on the subject, this is now the go-to paper.

Some key points:

  • Isopropanol is rapidly absorbed, mostly in the first 30 minutes after ingestion.
  • Isopropanol toxicity typically presents with CNS depression along with an increased osmol gap with ketonemia and/or ketonuria without metabolic acidosis.
  • Although it was previously thought that the metabolite acetone primarily caused the CNS depression, it now appears that isopropanol itself is the main culprit.
  • Some blood and urine tests for ketones may be misleading if they detect only β-hydroxybutyrate or acetoacetate but not acetone.
  • The presence of acetone may cause a factitious increased creatinine concentration with some assays.
  • Although hemodialysis effectively enhances elimination of isopropanol, it is rarely required unless the patient has renal failure (sometimes secondary to rhabdomyolysis) or is severely ill.

And of course this article brought mind Dock Boggs‘ very dark song “Old Rub Alcohol Blues”:

For more on Dock Boggs and “Old Rub Alcohol Blues,” click here.

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