Alcohol Toxicity Follow-up
- Author: Michael D Levine, MD; Chief Editor: Asim Tarabar, MD more...
Further Inpatient Care
See the list below:
- Patients with significant ingestions of toxic alcohols require hospital admission in a closely monitored setting such as the intensive care unit.
- Patients who are chronic alcoholics may be at risk of alcohol withdrawal if admitted to the hospital.
See the list below:
- Patients with ethanol intoxication can be observed until they are no longer clinically intoxicated and then discharged.
- Patients with isopropanol ingestion may require observation in the hospital.
- Patients with known or suspected methanol or ethylene glycol intoxication should be monitored closely, probably in an intensive care unit.
See the list below:
- Ethanol ingestion complications:
- Hypoglycemia is common. The etiology is multifactorial but largely related to decreased glycogen stores and malnutrition in children and chronic alcoholics, as well as ethanol’s inhibition of glycogenolysis.
- Patients with acute intoxication may exhibit "holiday heart," in which dysrhythmias, especially atrial fibrillation, occur following a heavy drinking episode. Ethanol lowers the threshold for developing atrial fibrillation.
- Cirrhosis, esophageal varices, and erosive gastritis are common in patients who use ethanol on a frequent basis.
- Ingestion of isopropanol is associated with hemorrhagic gastritis.
- Ingestion of methanol is associated with blindness, acidosis, coma, cardiovascular collapse, and death.
- Ingestion of ethylene glycol is associated with renal failure, acidosis, coma, cardiovascular collapse, and death.
Jammalamadaka D, Raissi S. Ethylene glycol, methanol and isopropyl alcohol intoxication. Am J Med Sci. 2010 Mar. 339(3):276-81. [Medline].
Hornfeldt CS. A report of acute ethanol poisoning in a child: mouthwash versus cologne, perfume and after-shave. J Toxicol Clin Toxicol. 1992. 30(1):115-21. [Medline].
Martz W. A lethal ingestion of a household cleaner containing pine oil and isopropanol. J Anal Toxicol. 2010 Jan-Feb. 34(1):49-52. [Medline].
Slaughter RJ, Mason RW, Beasley DM, Vale JA, Schep LJ. Isopropanol poisoning. Clin Toxicol (Phila). 2014 Jun. 52(5):470-8. [Medline].
ATSDR. Methanol toxicity. Agency for Toxic Substances and Disease Registry. Am Fam Physician. 1993 Jan. 47(1):163-71. [Medline].
Aufderheide TP, White SM, Brady WJ, et al. Inhalational and percutaneous methanol toxicity in two firefighters. Ann Emerg Med. 1993 Dec. 22(12):1916-8. [Medline].
Coulter CV, Farquhar SE, McSherry CM, Isbister GK, Duffull SB. Methanol and ethylene glycol acute poisonings - predictors of mortality. Clin Toxicol (Phila). 2011 Dec. 49(10):900-6. [Medline].
Cascallana JL, Gordo V, Montes R. Severe necrosis of oesophageal and gastric mucosa in fatal methanol poisoning. Forensic Sci Int. 2012 Mar 5. [Medline].
[Guideline] Caravati EM, Erdman AR, Christianson G, Manoguerra AS, Booze LL, Woolf AD, et al. Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005. 43 (5):327-45. [Medline].
Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015. 53 (10):962-1147. [Medline]. [Full Text].
Barceloux DG, Bond GR, Krenzelok EP, et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002. 40(4):415-46. [Medline].
Krahn J, Khajuria A. Osmolality gaps: diagnostic accuracy and long-term variability. Clin Chem. 2006 Apr. 52(4):737-9. [Medline].
Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med. 2009 May 21. 360(21):2216-23. [Medline].
Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008 Jan. 3(1):208-25. [Medline].
Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group. N Engl J Med. 1999 Mar 18. 340(11):832-8. [Medline].
Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of methanol poisoning. N Engl J Med. 2001 Feb 8. 344(6):424-9. [Medline].
Burns MJ, Graudins A, Aaron CK, et al. Treatment of methanol poisoning with intravenous 4-methylpyrazole. Ann Emerg Med. 1997 Dec. 30(6):829-32. [Medline].
Megarbane B, Borron SW, Baud FJ. Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med. 2005 Feb. 31(2):189-95. [Medline].
Lepik KJ, Levy AR, Sobolev BG, Purssell RA, DeWitt CR, Erhardt GD. Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Ann Emerg Med. 2009 Apr. 53(4):439-450.e10. [Medline].
Thanacoody RH, Gilfillan C, Bradberry SM, Davies J, Jackson G, Vale AJ, et al. Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS). Clin Toxicol (Phila). 2016. 54 (2):134-40. [Medline].
Ghannoum M, Hoffman RS, Mowry JB, Lavergne V. Trends in toxic alcohol exposures in the United States from 2000 to 2013: a focus on the use of antidotes and extracorporeal treatments. Semin Dial. 2014 Jul. 27(4):395-401. [Medline].