Professional Documents
Culture Documents
POISONING
Management with Ethanol
MECHANISM OF ACTION
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE
METHANOL
FORMALDEHYDE
FORMIC ACID
MECHANISM OF ACTION
METHANOL
OCULAR TOXICITY
INHIBITION OF MITOCHONDRIAL RESPIRATION INCREASED FORMIC ACID TOXICITY
FORMALDEHYDE
FORMIC ACID
CIRCULUS HYPOXICUS
LACTIC ACID PRODUCTION
ACIDOSIS
ACIDOSIS
GENERAL TOXICITY
AFTER 12 - 24 HOUR DELAY - PROGRESSION TO ACIDOSIS AND OTHER SIGNS AND SYMPTOMS
INVESTIGATION
BLOOD METHANOL LEVEL! ABG - METABOLIC ACIDOSIS OSMOLAL GAP - INCREASED (METHANOL) ANION GAP - INCREASED (FORMIC ACID, LACTIC ACID) BLOOD ETHANOL MAGNESIUM, AMYLASE, POTASSIUM
TREATMENT
HAZARD ASSESSMENT ABCs TOXICOKINETICS ABSORPTION DISTRIBUTION METABOLISM ELIMINATION
TREATMENT
CORRECTION OF METABOLIC ACIDOSIS BICARBONATE (AGGRESSIVE TREATMENT) CAN REVERSE VISUAL IMPAIRMENT REDUCES MOVEMENT OF FORMATE TO THE CNS MAY REQUIRE 400 TO 600 MMOL DURING FIRST FEW HOURS
REHYDRATION
MECHANISM OF ACTION
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE
METHANOL
FORMALDEHYDE
FORMIC ACID
MECHANISM OF ACTION
METHANOL
FORMALDEHYDE
FORMIC ACID
ALCOHOL DEHYDROGENASE
ALDEHYDE DEHYDROGENASE
ETHANOL
ALDEHYDE
ACETIC ACID
TREATMENT
ETHANOL
(REDUCES FORMATION OF TOXIC METABOLITES)
MAINTAIN BLOOD ETHANOL LEVEL OF 100 - 150 mg/dl LOADING DOSE BEWARE OF EXISTING ETHANOL LEVEL MAINTENANCE DOSE TITRATED AGAINST RATE OF ELIMINATION NON-ALCOHOLIC CHRONIC ALCOHOLIC CHILD 15 - 20 mg/dl/h 30 - 40 mg/dl/h 30 mg/dl/h
TREATMENT
ETHANOL
INDICATIONS BLOOD METHANOL LEVELS GREATER THAN 6.25 mmol/l (20 mg/dl) IF HAEMODIALYSIS IS TO BE COMMENCED
TREATMENT
ETHANOL
TREATMENT
HAEMODIALYSIS
METHANOL LOW MOLECULAR WEIGHT NOT PROTEIN BOUND LOW VOLUME OF DISTRIBUTION THEREFORE IDEAL FOR HAEMODIALYSIS
TREATMENT
HAEMODIALYSIS
INDICATIONS
ANY DEGREE OF VISUAL IMPAIRMENT
METABOLISM
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE
METHANOL
FORMALDEHYDE
FORMIC ACID
THF
TREATMENT
FOLINIC ACID/FOLIC ACID 50 mg IV EVERY FOUR HOURS FOR 24 HOURS, OR WHILE FORMIC ACID MAY STILL BE ACCUMULATING
METHYLATED SPIRITS
METHYLATED SPIRITS IS 5% METHANOL, 95% ETHANOL
METHYLATED SPIRITS
EXAMPLE
IF 250 ml METHYLATED SPIRITS INGESTED:
METHYLATED SPIRITS
EXAMPLE
IF 1.5 l METHYLATED SPIRITS INGESTED OVER SEVERAL DAYS: BLOOD ETHANOL LEVEL ~ 450 mg/dl (LD50) BLOOD METHANOL LEVEL = 142 mg/dl (IN 12 HOURS ETHANOL LEVEL = 100 mg/dl METHANOL LEVEL = 124 mg/dl)