Acute isopropyl alcohol intoxication: Diagnosis and management

doi:10.1016/0002-9343(83)90456-4

The American Journal of Medicine

Volume 75, Issue 4, October 1983, Pages 680-686

https://doi.org/10.1016/0002-9343(83)90456-4 Get rights and content

Abstract

Alcohol intoxication (methyl, ethyl, isopropyl, and ethylene glycol) is treated frequently in emergency room and intensive care units. Although high morbidity and mortality rates exist, effective therapies for methyl alcohol and ethylene glycol (ethyl alcohol blocking and hemodialysis) and ethyl and isopropyl alcohol (hemodialysis) are available. Prompt and accurate clinical and laboratory differentiation is needed to optimize these therapies. This review presents clinical, pharmacologic, and management data, contrasts important aspects in differential diagnosis, and suggests an appropriate approach to management of isopropyl alcohol Intoxication.

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Cited by (93)

Optical isopropanol biosensor using NADH-dependent secondary alcohol dehydrogenase (S-ADH)
2016, Talanta
Citation Excerpt :
Also, IPA is widely used in hospitals as the antiseptic alcohol gel for and disinfectant. From a medical point of view, IPA rarely exists in the human body or only in very low concentration unless accidental ingestion or exposure to gaseous IPA [4,5]. Recently, several studies reported that IPA could be measured in plasma or urine from ketoacidosis patients, who had not been exposed to or ingested IPA [6,7].
Isopropanol (IPA) is an important solvent used in industrial activity often found in hospitals as antiseptic alcohol rub. Also, IPA may have the potential to be a biomarker of diabetic ketoacidosis. In this study, an optical biosensor using NADH-dependent secondary alcohol dehydrogenase (S-ADH) for IPA measurement was constructed and evaluated. An ultraviolet light emitting diode (UV-LED, λ=340 nm) was employed as the excitation light to excite nicotinamide adenine dinucleotide (NADH). A photomultiplier tube (PMT) was connected to a two-way branch optical fiber for measuring the fluorescence emitted from the NADH. S-ADH was immobilized on the membrane to catalyze IPA to acetone and reduce NAD⁺ to be NADH. This IPA biosensor shows highly sensitivity and selectivity, the calibration range is from 500 nmol L⁻¹ to 1 mmol L⁻¹. The optimization of buffer pH, temperature, and the enzyme-immobilized method were also evaluated. The detection of IPA in nail related cosmetic using our IPA biosensor was also carried out. The results showed that large amounts of IPA were used in these kinds of cosmetics. This IPA biosensor comes with the advantages of rapid reaction, good reproducibility, and wide dynamic range, and is also expected to use for clinical IPA detections in serum or other medical and health related applications.
Isopropanol
2016, Medicine (United Kingdom)
Citation Excerpt :
Other features following ingestion include haemorrhagic gastritis (although this has also been reported after topical application),13 haematemesis, hypotension,10,12,14 hypothermia, sinus tachycardia,8 frequent premature ventricular beats,8 renal tubular necrosis, acute myopathy and haemolytic anaemia. Development of hypotension is a poor prognostic feature5,15 and can herald cardiac arrest.5,14 There is no evidence that gastric lavage is of value in reducing absorption, nor would this be expected, as absorption is rapid.
Determination of sevoflurane and isopropyl alcohol in exhaled breath by thermal desorption gas chromatography-mass spectrometry for exposure assessment of hospital staff
2015, Journal of Pharmaceutical and Biomedical Analysis
Volatile anaesthetics and disinfection chemicals pose ubiquitous inhalation and dermal exposure risks in hospital and clinic environments. This work demonstrates specific non-invasive breath biomonitoring methodology for assessing staff exposures to sevoflurane (SEV) anaesthetic, documenting its metabolite hexafluoroisopropanol (HFIP) and measuring exposures to isopropanol (IPA) dermal disinfection fluid. Methods are based on breath sample collection in Nalophan bags, followed by an aliquot transfer to adsorption tube, and subsequent analysis by thermal desorption gas chromatography–mass spectrometry (TD-GC–MS). Ambient levels of IPA were also monitored. These methods could be generalized to other common volatile chemicals found in medical environments. Calibration curves were linear (r² = 0.999) in the investigated ranges: 0.01–1000 ppbv for SEV, 0.02–1700 ppbv for IPA, and 0.001–0.1 ppbv for HFIP. The instrumental detection limit was 10 pptv for IPA and 5 pptv for SEV, both estimated by extracted ion-TIC chromatograms, whereas the HFIP minimum detectable concentration was 0.5 pptv as estimated in SIM acquisition mode. The methods were applied to hospital staff working in operating rooms and clinics for blood draws. SEV and HFIP were present in all subjects at concentrations in the range of 0.7–18, and 0.002–0.024 ppbv for SEV and HFIP respectively. Correlation between IPA ambient air and breath concentration confirmed the inhalation pathway of exposure (r = 0.95, p < 0.001) and breath-borne IPA was measured as high as 1500 ppbv. The methodology is easy to implement and valuable for screening exposures to common hospital chemicals. Although the overall exposures documented were generally below levels of health concern in this limited study, outliers were observed that indicate potential for acute exposures.
Inhibition of heparin precipitation, bacterial growth, and fungal growth with a combined isopropanol-ethanol locking solution for vascular access devices
2015, Journal of Pediatric Surgery
Clinical reports of ethanol-lock use for the prevention of catheter-related bloodstream infections have been marked by the occurrence of serious catheter occlusions, particularly among children with mediports. We hypothesized that precipitate forms when ethanol mixes with heparin at the concentrations relevant for vascular access devices, but that the use of a combination of two alcohols, ethanol and isopropanol, would diminish heparin-related precipitation, while retaining anti-bacterial and anti-fungal effects.
Heparin (0–100 units/mL) was incubated in ethanol–water solutions (30%–70% vol/vol) or in an aqueous solution containing equal parts (35% and 35% vol/vol) of isopropanol and ethanol. Precipitation at temperatures from 4 to 40 °C was measured in nephelometric turbidity units using a benchtop turbidimeter. Growth of Escherichia coli, Staphylococcus aureus, and Candida albicans colonies were measured following exposure to solutions of ethanol or isopropanol–ethanol. Groupwise comparisons were performed using analysis of variance with Bonferroni-corrected, post-hoc T-testing.
Seventy percent ethanol and heparin exhibit dose-dependent precipitation that is pronounced and significant at the concentrations typically used in mediports (p < 0.05). Precipitate is significantly reduced by use of a combined 35% isopropanol–35% ethanol solution rather than 70% ethanol (p < 0.05), while maintaining the solution's anti-bacterial and anti-fungal properties. On the other hand, although ethanol solutions under 70% form less precipitate with heparin, such concentrations are also less effective at bacterial colony inhibition than solutions of either 70% ethanol or 35% isopropanol–35% ethanol (p < 0.05).
A combined 35% isopropanol–35% ethanol locking solution inhibits bacterial and fungal growth similarly to 70% ethanol, but results in less precipitate than 70% ethanol when exposed to heparin. Further study of a combined isopropanol–ethanol locking solution for the prevention of catheter-related bloodstream infections should focus on the determination as to whether such a locking solution may reduce the rate of precipitation-related catheter occlusion, and whether it may be administered with low systemic toxicity.
Toxigenic and Metabolic Causes of Ketosis and Ketoacidotic Syndromes
2012, Critical Care Clinics
Citation Excerpt :
As little as 20 mL (50% solution) may induce symptoms in adults.105 Serum levels greater than 150 mg/dL lead to coma and hypotension, although 1 study reported that levels greater than 400 mg/dL were associated with these findings.103 Abdominal pain, nausea, vomiting, and diarrhea may develop within 30 minutes of ingestion, together with altered mentation.
Short-term immunological effects of non-ethanolic short-chain alcohols
2012, Toxicology Letters
Short-chain alcohols are embedded into several aspects of modern life. The societal costs emanating from the long history of use and abuse of the prototypical example of these molecules, ethanol, have stimulated considerable interest in its general toxicology. A much more modest picture exists for other short-chain alcohols, notably as regards their immunotoxicity. A large segment of the general population is potentially exposed to two of these alcohols, methanol and isopropanol. Their ubiquitous nature and their eventual use as ethanol surrogates are predictably associated to accidental or deliberate poisoning. This review addresses the immunological consequences of acute exposure to methanol and isopropanol. It first examines the general mechanisms of short-chain alcohol-induced biological dysregulation and then provides a tentative model to explain the molecular events that underlie the immunological dysfunction produced by methanol and isopropanol. The time-related context of serum alcohol concentrations in acute poisoning, as well as the clinical implications of their short-term immunotoxicity, is also discussed.

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¹: From the Departments of Medicine, Children's Hospital Medical Center and Cambridge Hospital; the Department of Pediatrics, Boston City Hospital; the Department of Pediatrics and Medicine, Harvard Medical School; and the Massachusetts Poison Control System, Boston, Massachusetts.

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ReviewAcute isopropyl alcohol intoxication: Diagnosis and management

Abstract

J Am Pharm Assoc

J Pediatr

The epidemiology of poisoning from drug products

Am J Dis Child

Isopropyl alcohol: rate of disappearance from the blood stream of dogs after intravenous and oral administration

J Pharmacol Exp Ther

The pharmacology of isopropyl alcohol

J Lab Clin Med

Acute poisoning from use of isopropyl alcohol in tepid sponging

JAMA

Coma produced by topical application of isopropanol

Pediatrics

Isopropyl alcohol

J Pharmacol Exp Ther

Isopropyl alcohol metabolism after acute intoxication in humans

J Anal Toxicol

The acute and chronic toxicity of isopropyl alcohol

J Lab Clin Med

Isopropyl alcohol—an investigation of its physiological properties

J Lab Clin Med

Fatal intoxication with isopropyl alcohol (rubbing alcohol)

Am J Clin Pathol

A toxicological study of some alcohols with special reference to isomers

J Pharmacol Exp Ther

Review
Acute isopropyl alcohol intoxication: Diagnosis and management