Toxicology
Ethanol may be administered by diluting 95% alcohol for intravenous, oral, or per-tube administration.
Mechanism of action is competitive inhibition of alcohol dehydrogenase.
Alcohol dehydrogenase has a higher affinity for ethanol.
Intravenous alcohol preparations are no longer commercially available and must be compounded.
| d. | Initial dosing is 600–700 mg (7.6–8.9 mL/kg) of a 10% solution, followed by an infusion of 66 |
|---|
mg/kg/hour (0.83 mL/kg/hour). The infusion dose may be initiated at 154 mg/kg/hour (1.96 mL/
kg/hour) in chronic drinkers. The goal is to maintain a serum ethanol concentration of 100 mg/dL
(0.1%) until symptoms have diminished and methanol or ethylene glycol serum concentrations are
Disadvantages include frequent monitoring and ICU admission in some institutions.
Adverse effects include CNS depression, nausea, vomiting, abdominal pain, polyuria, and
hypoglycemia (especially in children).
Hemodialysis should be considered if the clinical condition deteriorates, as evidenced by:
Methanol/ethylene glycol concentration greater than 50 mg/dL
Significant metabolic acidosis
Development of acute renal failure (ethylene glycol) or visual disturbances (methanol)
| d. | Development of significant electrolyte abnormalities |
|---|
Additional therapies
Pyridoxine and thiamine
Serve as cofactors in the metabolism of the toxic metabolites of ethylene glycol to nontoxic
metabolites
ii.
Pyridoxine promotes the metabolism of glyoxylate to glycine.
| (a) | Dosing is generally recommended to be one or more intravenous doses of 50 mg |
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iii.
Thiamine promotes the metabolism of glycolic acid to a nontoxic metabolite and is also used
to prevent or treat Wernicke-Korsakoff syndrome.
| (a) | Dosing is generally recommended as 100 mg intravenously, although a concomitant history |
|---|
of chronic alcohol use may warrant use of higher doses (e.g., 500 mg).
Folinic acid
Serves as a cofactor in the metabolism of the toxic metabolites of methanol to nontoxic
metabolites. May reduce formate accumulation and reduce the development of metabolic
| (a) | Dosing is generally recommended to be 1 mg/kg (maximum of 50 mg) intravenously at |
|---|
4-hour intervals
ii.
Folic acid may be used if folinic acid is unavailable.
Dextrose
Recommended to check a point-of-care level blood glucose concentration before administration
ii.
Administer 50 mL of 50% dextrose in water if blood glucose is 70 mg/dL or less or if testing
is unavailable.
| d. | Magnesium – Recommended to administer 1–2 g intravenously for hypomagnesemia (more |
|---|
common in chronic alcohol use)
Antiseizure medications
Benzodiazepines are the preferred emergent agents to treat seizures.
ii.
Subsequent urgent control therapy can be implemented with intravenous fosphenytoin,
valproate sodium, phenobarbital, or levetiracetam.
| (a) | Phenytoin and fosphenytoin would not be recommended for patients with a history of |
|---|
chronic ethanol ingestion due to enhanced phenytoin metabolism (Clin Pharmacol Ther.
1981;30(3):390-397.