Toxic alcohol diagnosis and management: an emergency medicine review

Abstract

Toxic alcohols are a group of substances containing a hydroxyl group not meant to be ingested. They are the cause of a significant number of accidental and non-accidental exposures. Toxic alcohol poisoning can be associated with a significant degree of morbidity and mortality if not promptly recognized and treated. This review describes the clinical presentation and an approach to the recognition and management for toxic alcohol poisoning. Toxic alcohols classically refer to a group of alcohols not meant for ingestion. Methanol, ethylene glycol, and isopropyl alcohol are readily available in common hardware and household materials. Toxic alcohols are ingested for a variety of reasons including accidental exposures, intentional inebriation, homicide and suicide. The patient with an altered mental status or concerning history warrants consideration of this potentially deadly ingestion. Treatment considerations include alcohol dehydrogenase blockade and hemodialysis. Toxic alcohol poisoning can be an elusive diagnosis. This review evaluates toxic alcohol poisoning signs and symptoms and an approach to diagnosis and management.

Rrefractory Metabolic Acidosis in a Diabetic Patient : A case of Unsuspected Methanol Intoxication

“…In general, high AG metabolic acidosis caused by excessive endogenous acid is usually more common 6 . Methanol is metabolized by alcohol dehydrogenase to formaldehyde and then transformed to formic acid by aldehyde dehydrogenase 7 . Accumulation of formic acid can cause damage to the retina and optic nerve, resulting in changes in the histological morphology and function of the tissues and ultimately leading to blindness 8 .…”

Methanol Poisoning and Its Treatment

“…Patients can present with various non-specific symptoms 12-24 h after methanol ingestion. Common symptoms include abdominal pain, headache, nausea, vomiting, and visual disturbances, which may be described as cloudy or blurry vision [9].…”

“…The presence of severe metabolic acidosis with an anionic and osmolality gap is strongly suggestive of the existence of methanol or ethylene glycol toxicity, and the clinical manifestations and mortality of patients are significantly associated with metabolic acidosis and central nervous system weakening [9]. In the neurological examination, the poisoned may have impaired walking or imbalance, and cerebral hemorrhage is a rare condition that has been reported in some cases [10].…”

“…Serial serum bicarbonate change is more helpful than bicarbonate itself. A review study published by Patrick chow Yuen Ng and his colleagues in 2018 suggests that a person suspected of methanol intoxication should be examined every 2-4 hours for 12 hours [9].…”

Leveraging genetic data to investigate molecular targets and drug repurposing candidates for treating alcohol use disorder and hepatotoxicity

“…Many of the drugs are promising candidates for managing liver toxicity. Fomepizole (ADH1A, ADH1B, ADH1C) blocks alcohol dehydrogenase and is already approved to treat methanol and ethylene glycol toxicity (35).…”