The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article

Keywords: Alcohols, Ethylene Glycol, Isopropanol, Methanol, Patient Care Management, Poisoning

Abstract

Context: This review discusses the range of clinical presentations seen with poisonings by the major toxic alcohols--methanol, ethylene glycol, and isopropyl alcohol. It outlines a straightforward diagnostic strategy and discusses in detail the current treatment recommendations. Evidence acquisition: The authors conducted a literature search of primary and secondary sources related to the topic. For treatment recommendations, search restrictions included articles published between 2008 and 2019. For background information, search restrictions included articles written from 1990 – present. Results: This review discusses in detail how the diagnosis can be made via clinical signs, symptoms, and laboratory values as well as the most recent treatment recommendations. This paper will also discuss the limitations of the emergency department workup and how the absence of particular laboratory findings does not necessarily rule out the diagnosis. Conclusion: Poisoning with methanol, ethylene glycol, and isopropanol present diagnostic and therapeutic challenges to emergency physicians. Toxic alcohol poisonings lead to an elevated osmolar gap and, with the exception of Isopropanol, a metabolic acidosis. In order for the timely initiation of life-saving treatment, emergency physicians need a solid understanding of the pathophysiology, clinical presentation, laboratory workup, and treatment. Laboratory assays for these compounds are send-out tests in most hospitals and are therefore of no value in the acute clinical setting.

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Author Biographies

Nicholas Gallagher, Department of Emergency Medicine, Arnot Ogden Medical Center, Elmira, New York, USA

Dr. Gallagher graduated in 2019 from the emergency medicine residency at the Arnot Ogden Medical Center in Elmira, New York. He is beginning a fellowship in Addiction Medicine at Brown University in Providence, Rhode Island.

Frank J Edwards, Department of Emergency Medicine, Arnot Ogden Medical Center, Elmira, New York, USA

Dr. Edwards was the program director of the emergency medicine residency at the Arnot Ogden Medical Center in Elmira, New York from 2014 to 2019. He now serves as the GME DIO for the same institution.

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Published
2019-05-22
How to Cite
Gallagher, N., & Edwards, F. (2019). The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Advanced Journal of Emergency Medicine, 3(3), e28. https://doi.org/10.22114/ajem.v0i0.153
Section
Review article