Correct!
5. All of the above
The alcohols are responsible for the majority of the osmolal gap, whereas their organic acid metabolites elevate the anion gap (4). Principles for treatment of poisoning by the alcohols include removal of the alcohol and slow conversion of the alcohols to their toxic acid metabolites by inhibition of alcohol dehydrogenase. Bicarbonate potentially may help to decrease the amount of active organic acid metabolites. Alcohol absorption by the gastrointestinal tract is rapid and gut decontamination is not indicated. However, the alcohols can be removed by hemodialysis.
With the exception of isopropyl alcohol, the alcohols have minimal toxicity in comparison to their metabolites. The alcohols are metabolized first by alcohol dehydrogenase (Figure 2).
Figure 2. The alcohols are metabolized to aldehydes by alcohol dehydrogenase which are further metabolized by aldehyde dehydrogenase to organic acids.
Inhibition of alcohol dehydrogenase lowers the concentration of the toxic metabolites. Antidote therapy, often using ethanol or fomepizole, is directed towards delaying metabolism until the alcohol is eliminated from the patient’s system either naturally or via dialysis.
Our patient was given sodium bicarbonate and begun on fomeizole and hemodialysis. He rapidly improved and was eventually discharged.
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