Alcohol Toxicity Follow-up

  • Author: Michael D Levine, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 11, 2009
 

Further Inpatient Care

  • 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.
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Transfer

  • 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.
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Complications

  • Ethanol ingestion complications
    • Hypoglycemia is common.[14] 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.[10]
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Contributor Information and Disclosures
Author

Michael D Levine, MD  Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center; Physician, Department of Emergency Medicine, Banner Thunderbird Medical Center

Michael D Levine, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Tobias D Barker, MD  Attending Physician, Department of Emergency Medicine; Director, Harvard Medical School Dubai Center Simulation Center

Tobias D Barker, MD is a member of the following medical societies: American College of Emergency Physicians, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI, Columbus, Ohio

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. 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].

  2. ATSDR. Methanol toxicity. Agency for Toxic Substances and Disease Registry. Am Fam Physician. Jan 1993;47(1):163-71. [Medline].

  3. Aufderheide TP, White SM, Brady WJ, et al. Inhalational and percutaneous methanol toxicity in two firefighters. Ann Emerg Med. Dec 1993;22(12):1916-8. [Medline].

  4. Barceloux DG, Krenzelok EP, Olson K, et al. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999;37(5):537-60. [Medline].

  5. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  6. 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].

  7. Krahn J, Khajuria A. Osmolality gaps: diagnostic accuracy and long-term variability. Clin Chem. Apr 2006;52(4):737-9. [Medline].

  8. Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med. May 21 2009;360(21):2216-23. [Medline].

  9. Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. Jan 2008;3(1):208-25. [Medline].

  10. 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. Mar 18 1999;340(11):832-8. [Medline].

  11. Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of methanol poisoning. N Engl J Med. Feb 8 2001;344(6):424-9. [Medline].

  12. Burns MJ, Graudins A, Aaron CK, et al. Treatment of methanol poisoning with intravenous 4-methylpyrazole. Ann Emerg Med. Dec 1997;30(6):829-32. [Medline].

  13. Megarbane B, Borron SW, Baud FJ. Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med. Feb 2005;31(2):189-95. [Medline].

  14. 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. Apr 2009;53(4):439-450.e10. [Medline].

 
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