Metabolic Acidosis in a Patient With Isopropyl Alcohol Intoxication: A Case Report
Authors: Xiaomei Meng, Suman Paul, Douglas J. Federman
Journal: Annals of Internal Medicine (2015)

Letters17 February 2015Metabolic Acidosis in a Patient With Isopropyl Alcohol Intoxication: A Case ReportXiaomei Meng, MD, PhD, Suman Paul, MBBS, PhD, and Douglas J. Federman, MDXiaomei Meng, MD, PhDFrom University of Toledo Medical Center, Toledo, Ohio; and University of Toledo College of Medicine, Toledo, Ohio.Search for more papers by this author, Suman Paul, MBBS, PhDFrom University of Toledo Medical Center, Toledo, Ohio; and University of Toledo College of Medicine, Toledo, Ohio.Search for more papers by this author, and Douglas J. Federman, MDFrom University of Toledo Medical Center, Toledo, Ohio; and University of Toledo College of Medicine, Toledo, Ohio.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5053 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: An elevated plasma osmolal gap is common in all forms of alcohol intoxication. Methyl alcohol and ethylene glycol are metabolized to compounds that produce metabolic acidosis. Isopropyl alcohol, however, is metabolized to acetone, which does not cause metabolic acidosis and cannot be metabolized to compounds that do (1). Therefore, the presence of metabolic acidosis is used to rule out isopropyl alcohol intoxication. This distinction is important because fomepizole is used to treat methyl alcohol and ethylene glycol intoxication but is contraindicated in isopropyl alcohol intoxication because it reduces the clearance of isopropyl alcohol and thus prolongs its effects (2).... References1. Slaughter RJ, Mason RW, Beasley DM, Vale JA, Schep LJ. Isopropanol poisoning. Clin Toxicol (Phila). 2014;52:470-8. [PMID: 24815348] doi:10.3109/15563650.2014.914527 CrossrefMedlineGoogle Scholar2. Pappas AA, Ackerman BH, Olsen KM, Taylor EH. Isopropanol ingestion: a report of six episodes with isopropanol and acetone serum concentration time data. J Toxicol Clin Toxicol. 1991;29:11-21. [PMID: 2005658] CrossrefMedlineGoogle Scholar3. Mihai B, Lacatusu C, Graur M. [Alcoholic ketoacidosis]. Rev Med Chir Soc Med Nat Iasi. 2008;112:321-6. [PMID: 19294998] MedlineGoogle Scholar4. Sivilotti MLA. Isopropyl alcohol poisoning. UpToDate. 2013. Accessed at www.uptodate.com/contents/isopropyl-alcohol-poisoning?source=search_result&search=isopropyl&selectedTitle=1~31 on 7 August 2014. Google Scholar Author, Article, and Disclosure InformationAuthors: Xiaomei Meng, MD, PhD; Suman Paul, MBBS, PhD; Douglas J. Federman, MDAffiliations: From University of Toledo Medical Center, Toledo, Ohio; and University of Toledo College of Medicine, Toledo, Ohio.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L14-0336. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIatrogenic and Poison-Derived Acid Base Disorders 17 February 2015Volume 162, Issue 4Page: 322-323KeywordsAcetonesAcidosisAlcoholicsAlcoholismAlcoholsBlood plasmaEatingEthanolEthyleneIntoxication ePublished: 17 February 2015 Issue Published: 17 February 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...