Toxicology

(ESETT) presenting with toxin-related status epilepticus found that a single dose of a

second-line antiseizure medication (ie, levetiracetam, fosphenytoin, valproate) was only

effective 42% of the time, with both fosphenytoin and valproate performing particularly

Patient should be closely monitored for resolution of clinical symptoms and return to baseline mental

status.

Arterial blood gases with a goal of pH greater than 7.2

Methanol/ethylene glycol concentrations with a goal of less than 20 mg/dL

Monitor the osmolar and anion gaps to ensure the toxic alcohol and metabolites are being cleared

appropriately.

Patient Cases

A 35-year-old man is admitted to the ED appearing inebriated. He is alert but oriented only to person. His

vital signs are BP 122/80 mm Hg, HR 82 beats/minute, and RR 25 breaths/minute. His serum ethanol con-

centration is 20 mg/dL, and his ethylene glycol concentration is 100 mg/dL. Which is the most appropriate

therapy at this time?

A patient with methanol intoxication is initiated on fomepizole treatment together with hemodialysis. After

the 15-mg/kg bolus dose is given, which would be best for adjusting the maintenance fomepizole doses dur-

ing dialysis?

Alcohol withdrawal is a relatively common consequence of hospital admission.

Additional tools have been developed, such as the Prediction of Alcohol Withdrawal Severity Scale,

to help identify patients at risk for alcohol withdrawal before development of severe symptoms

Withdrawal symptoms typically occur within 8 hours after blood alcohol concentrations decrease, peak

at 72 hours, and are markedly reduced at 5–7 days (N Engl J Med 2014;371:2109-13).