Sunday August 10, 2008

Case: 28 year old male has been brought to ED with possible ethylene glycol toxicity. Osmol gap is greater than 10 mOsm/L and reportedly urinary oxalate crystals are present. Unfortunately, Fomepizole is not available and you decide to treat patient with Ethanol. Before initiating treatment which lab value you would like to see?

Answer: ethanol level itself

Its not uncommon to have both Ethanol and Ethylene Glycol ingestion together. Overly aggressive ethanol administration may cause apnea that required intubation.

Goal is to maintain blood ethanol levels 100-150 mg/dL. Measuring initial blood level is important; if more than 100 mg/dL, loading dose may be unnecessary.

Doses:
IV loading dose: 7-10 mL/kg IV of 10% ethanol (V/V) in dextrose 5% in water over 30 min to achieve blood ETOH concentration of 100-130 mg/dL (21.7-28.2 mmol/L)
Oral loading dose: 1 mL/kg of 95% ethanol mix with orange juice over 30 min
Average maintenance PO dose: 0.15 mL/kg/h of 95% ETOH
Average maintenance IV dose:1.5 mL/kg/h of a 10% solution