Isopropyl Alcohol (part 1) – Recognition

15 May

ISOPROPYL ALCOHOL – Central nervous system (CNS) inebriant and depressant.  Toxicity and treatment resemble that of ethanol.

 

EPIDEMIOLOGY – Fatality from isolated isopropyl alcohol toxicity is rare, but can result from injury due to inebriant effects, untreated coma with airway compromise, or rarely, cardiovascular depression and shock following massive ingestion. 

 

PHARMACOLOGY AND TOXICOLOGY — a CNS depressant whose toxicity closely resembles that of ethanol, with which it shares strong structural similarity.  

In untreated animals, the median lethal dose lies between 4 and 8 g/kg.

Isopropyl alcohol does NOT cause an elevated anion gap acidosis, unlike the toxic alcohols methanol and ethylene glycol.  Why?  Because Ketones cannot be oxidized to carboxylic acids.

Isopropyl alcohol is metabolized by the alcohol dehydrogenase family of enzymes to acetone. 

Following ingestion, the elimination of acetone is slower than its formation, and this metabolic end-product accumulates.  Acetone itself is a mild CNS depressant and may exacerbate the CNS depression caused by isopropyl alcohol.  It is also responsible for the marked ketosis that is present in most isopropyl alcohol ingestions.

 

KINETICS – Peak serum concentration and clinical effects occur approximately one to two hours after ingestion.

 

CLINICAL FEATURES OF OVERDOSE

Symptoms – nausea, vomiting, and abdominal pain.

Signs – CNS Depressive effects peak within the first hour after ingestion.  Can cause an alteration in mental status similar to that seen in ethanol intoxication.

A fruity breath odor is often perceptible, suggesting acetone accumulation.

Following massive ingestion, signs of shock may be present, as may hematemesis (gastric irritant), pulmonary edema, and hemorrhagic tracheobronchitis.

 

Submitted by Christina Brown.
References: uptodate.com; Trullas JC, Aguilo S, Castro P, Nogue S. Life-threatening isopropyl alcohol intoxication: is hemodialysis really necessary? Vet Hum Toxicol 2004; 46:282. Stremski E, Hennes H. Accidental isopropanol ingestion in children. Pediatr Emerg Care 2000; 16:238. Bekka R, Borron SW, Astier A, et al. Treatment of methanol and isopropanol poisoning with intravenous fomepizole. J Toxicol Clin Toxicol 2001; 39:59.  Su M, Hoffman RS, Nelson LS. Error in an emergency medicine textbook: isopropyl alcohol toxicity. Acad Emerg Med 2002; 9:175.; picture

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