Poisoning by alcohols and glycols

Abstract

Ethanol intoxication is commonly encountered and can cause hypotension, hypoglycaemia, lactic acidosis, seizures and coma. Isopropyl alcohol and its metabolite acetone cause profound depression of the central nervous system with rapid onset. Toxic alcohols include methanol, ethylene glycol and diethylene glycol; these can cause severe metabolic acidosis, acute renal failure and, for methanol, severe visual disturbance. Toxicity is attributable to metabolites and there is a characteristic delay between ingestion and the occurrence of severe toxicity. Assessment of the extent of exposure requires laboratory confirmation of toxic alcohol concentrations, which conventionally involves specialized laboratory assays that are not always readily available. Management strategies include assessment of toxic alcohol exposure, early administration of fomepizole to prevent formation of metabolites and, in patients with established poisoning, haemodialysis to remove metabolites.