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viernes, 25 de septiembre de 2015

Alcoholes tóxicos

emDocs - September 16, 2015 - By Bodford I - Edited by Koyfman A and Alerhand S
"Major Points
– Always have toxic alcohol ingestion in the differential when seeing an inebriated patient. Although rare, having a high clinical suspicion can help save lives. Obtain a thorough history from any and all persons involved.
– Methanol: byproducts cause an elevated anion gap metabolic acidosis. Effects of ingestion are inebriation (less so than ethanol, ethylene glycol, or isopropanol), Parkinsonism, transverse myelitis, and basal ganglia hemorrhages. Patients also might complain of “snowstorm” vision.
– Ethylene glycol: byproducts cause an elevated anion gap metabolic acidosis. Effects of ingestion are inebriation, coma, seizures, meningismus, muscle spasms, and paralysis of the extraocular muscles. Also causes tachycardia, hyperventilation, ARDS, and heart failure. One of the byproducts of breakdown combines with calcium to form crystals. These deposit in the kidney leading to kidney injury and can cause hypocalcemia with resulting QT prolongation.
– Isopropanol: most commonly ingested toxic alcohol but does not lead to metabolic acidosis. Effects of ingestion are severe inebriation, fruity smelling breath, and hemorrhagic gastritis. Obtain a BMP, ethanol level, lactate, serum osmolarity, and an ABG/VBG. A serum osmolar gap of >10-25 mOsm in the setting of an anion gap is highly suggestive of toxic alcohol exposure. Examine the urine for crystals.
– Call the poison control center when toxic alcohol consumption is suspected. If suspicion is high enough,begin fomepizole administration prior to labs resulting as time equals tissue. Hemodialysis may ultimately be needed.Immediate transfer to another facility is warranted if fomepizole or hemodialysis are not available."
http://www.emdocs.net/the-unhappy-drunk-toxic-alcohols/