A 40 yrs old man , known history of alcohol abuse , brought drowsy and vomiting blood after 2 hours of drinking a whole bottle of the below product. On examination, He is drowsy but responding , GCS: 12/15 , blood sugar 7 mmol/l , vitals signs: pr: 100 , bp: 120/70 , RR: 20 , spo2: 99% in r.a , afebrile with normal rest of exam .
Q1.What are the expected toxicity ?
Q2. How will you managed this patient?
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Sanitized Stomach cont,
Thank you all for your comments Isopropyl alcohol is used widely as a solvent, an antiseptic, and a disinfectant and is commonly available in hand sanitizer as 70% solution (rubbing alcohol).
It is often ingested by alcoholics as a cheap substitute for liquor. Unlike the other common alcohol substitutes methanol and ethylene glycol, isopropyl alcohol is not metabolized to highly toxic organic acids and therefore does not produce a profound anion gap acidosis
It is metabolised by ADH to acetone, without production of an anion gap acidosis.
Toxicity is mainly limited to gastrointestinal effects (haemorrhagic gastritis) and neurological effects (profound intoxication, cerebellar signs, coma).
Isopropanol is the only toxic alcohol that causes ketosis without acidosis.
· Isopropyl alcohol is metabolized to acetone, which contributes to CNS depression and gives a distinct odor to the breath Methanol toxicity have been reported in cheap and low quality mainfuctured hand sanitizers , so be aware of the product used Diagnosis usually is based on a history of ingestion and the presence of an elevated osmole gap, the absence of severe acidosis, and the characteristic smell of isopropyl alcohol or its metabolite, acetone. · Treatment is supportive., · No role for fomepizole or ethanol References 1. Poisoning and Drug overdose 6th edition 2.https://litfl.com/toxic-alcohol-ingestion/
Good evening Dr.Suad ,
Thank you for sharing this great case with us
1-hand sanitizer gel contains about 60- 95 % of ethanol or isopropyl alcohol, so I expect this patient will develop alter mental state , slurred speech, ataxia, nausea and vomiting , respiratory depression , lethargy and coma
2- Manage ABCDE, will check his airway is patent
is he in respiratory distress, moitering vitals BP, RR, Spo2, PR , Temp
, GCS, pupil and not forget GLUCOSE
-he need plenty of IVF
-benzodiazepam if become agitated