Toxic Alcohols

Chemistry - Alcohols are hydrocarbons that contain one hydroxyl (OH) group.
- The term toxic alcohols traditionally refer to alcohols other than ethanol.
- The most common toxic alcohols encountered clinically are:
 Methanol (methyl alcohol, “colonial spirit,” wood alcohol, solvent alcohol)
 Ethylene glycol
 Isopropanol (isopropyl alcohol, IPA, rubbing alcohol)
- Primary alcohols, such as methanol and ethanol, contain a hydroxyl group on the
end of the molecule (the terminal carbon).
- Secondary alcohols, such as isopropanol, contain hydroxyl groups bound to
nonterminal carbons.
- The longer carbon chain, the greater toxicity, Exception is methanol which is more
toxic than ethanol.
- Dihydroxy alcohols are called Glycols.
- Glycol ethers are glycols with a hydrocarbon chain bound to one or more of the
hydroxyl groups.
Sources Methanol is a highly toxic alcohol that is widely used industrially as a solvent and in the
and Uses production of formaldehyde and methylated compounds. It is found in commercial
products such as gasoline, antifreeze, gasohol, windshield washer fluid, copy machine
fluid, canned heat (Sterno), paint, shellac, and solvents for removing wood finishes. There
also is a continuous discussion on the possible use of methanol as an alternative energy
source in combustion engines.
Methanol may be used as a denaturant for ethanol, sold relatively cheaply as methylated
spirits (meths) in low socioeconomic groups.
Ethylene glycol It is used widely as antifreeze in internal combustion engines and as a
solvent in various manufacturing processes.
Most commonly, isopropanol is found in rubbing alcohol as a 70% volume/volume
solution in water. It is important to note that not all rubbing alcohol is made with IPA, as
ethanol is also used. IPA also is found in solvents, inks, drug preparations, beauty
products, de-icing agents, and hand sanitizers.
Ethylene glycol Antifreeze Foam stabilizer
De-icing solutions Solvent
Humectant (stabilizer of moisture Chemical intermediate (polyester
content in tobacco, baked fibers, films, resins)
products, dentifrices) Condensers and heat exchangers
Brake fluid (hydraulic) Glycerin substitute (paints,
Cellophane softening agent lacquers, detergents, cosmetics)
Methanol Paints and varnishes Fuel octane booster
Industrial solvent Solvent for extraction and
Manufacture of formaldehyde, pharmaceutical use
acetic acid, methyl derivatives, Fuel (picnic stoves, torches)
inorganic acids, Antifreeze Copier fluids

Mokhtar Alhrani, MD
Acute  CNS inebriation effect: (isopropanol=ethylene glycol> ethanol >methanol).
Toxicity of  Metabolic Acidosis (AGMA):
Toxic  Isopropyl alcohol is known as the toxic alcohol that causes ketosis without
Alcohols acidosis.
 The anion gap and osmolal gap change with time and need to be interpreted in
relation to time of ingestion. Immediately after ingestion, the anion gap is often
normal and the osmolal gap is elevated since the toxic alcohol is in the
unmetabolized form. As time progresses and the alcohol is metabolized to an
acid, the osmolal gap will decrease and the anion gap will increase.
 Specific end organ effects:
 Methanol (formic Acid): Oculotoxicity.
 Ethylene glycol (oxalic Acid): Nephrotoxicity.
 Isopropanol (Acetone; ketone): Hemorrhagic gastritis.
Ethylene glycol poisoning seems to be more frequent than methanol intoxication in the
developed world, whereas methanol poisonings are far more frequent in the developing
world. Besides being the “poor man’s” substitute for ethanol, ethylene glycol has also
been used as suicidal agent – sometimes in “copy-cat” epidemics among young people.
Diagnostic  Toxic Alcohol Concentration (GC) not always available
Tests  Electrolytes, BUN, Creatinine, ABGs, Lactate Conc.
Management  Alcohol Dehydrogenase Inhibition
 Ethanol
 Fomepizole
 Hemodialysis
 Adjunctive Therapy
 Folate
 Leucovorin

Mokhtar Alhrani, MD
 The correlation between methanol and the osmolal gap and formate and the anion gap

Differential Characteristics of Alcohols:

Characteristic Methanol Ethanol Isopropanol Ethylene Glycol
Toxic Metabolite Formaldehyde Acetaldehyde Acetone Glycoaldehyde
Formic Acid Acetic Acid Oxalate
Acidosis Severe Mild to Moderate Mild Severe
Ketosis Mild to None Mild to Moderate Severe None
Anion Gap +++ ++ + +++
Increased serum Yes Yes Yes Yes
Osmolality
CNS depression + +++ ++ +
Lethal dose 1-2 mL/kg 3-6 mL/kg 1-4 mL/kg 1-2 mL/kg

Good luck

Mokhtar Alhrani, MD