Zeitschrift für klinische Toxikologie
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Approaching Acute Toxic Alcohol Poisoning: A Narrative Review

Kevin Tan, Balakrishnan Ashokka, Lawrence Siu-Chun Law, Elaine Ah-Gi Lo, Dhamodaran Palaniappan, Pankaj Kundra

Objective: Poisoning from toxic alcohols (methanol, ethylene glycol, diethylene glycol and isopropanol) occurs globally and results in significant morbidity and mortality. Consequently, toxic alcohol poisoning requires prompt diagnosis and management by healthcare workers at the acute presentation. As such, this narrative review aims to provide a practical approach to diagnosis and management of toxic alcohol poisoning.

Methods: PubMed and Scopus databases were searched for studies and clinical practice guidelines on the diagnosis and management of toxic alcohol poisoning.

Results: The osmolar gap, arterial pH, anion gap and serum alcohol concentrations should be evaluated in suspected cases of toxic alcohol poisoning. Gastrointestinal decontamination has limited efficacy due to rapid gastrointestinal absorption of toxic alcohols. Following acute resuscitation and stabilization, treatment modalities include Alcohol Dehydrogenase (ADH) inhibitors, Renal Replacement Therapy (RRT) and correction of metabolic derangements. ADH inhibitors are contraindicated in isopropanol poisoning as they delay its metabolism and clearance. Sodium bicarbonate as well as formic or folinic acid are recommended in methanol poisoning. Thiamine and pyridoxine are recommended in ethylene glycol poisoning.

Conclusion: Clinicians in the acute care setting should exercise a low threshold of suspicion for toxic alcohol poisoning due to the non-specific clinical features at presentation. Timely diagnosis is treatment is critical to minimize mortality and morbidity.