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

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


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.


Download data is not yet available.

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.


1. Williams R, Erickson T. Evaluating toxic alcohol poisoning in the emergency setting. Lab Med. 1998;29(2):102-8.
2. Kraut J, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3(1):208-25.
3. Latus J, Kimmel M, Alscher M, Braun N. Ethylene glycol poisoning: a rare but life-threatening cause of metabolic acidosis—a single-centre experience. Clin Kidney J. 2012;5(2):120-3.
4. Slaughter R, Mason R, Beasley D, et al. Isopropanol poisoning. Clin Toxicol (Phila). 2014;52(5):470-8.
5. McMartin K, Jacobsen D, Hovda K. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016;81(3):505-15.
6. Carstairs S, Suchard J, Smith T, Simon LV, Kalynych CJ, Shimada M, et al. Contribution of serum ethanol concentration to the osmol gap: a prospective volunteer study. Clin Toxicol (Phila). 2013;51(5):398-401.
7. Kraut J, Madias N. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol. 2007;2(1):162-74.
8. Marts L, Hsu D, Clardy P. Mind the Gap. Ann Am Thorac Soc. 2014;11(4):671-4.
9. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40(4):415-46.
10. Kraut J, Mullins M. Toxic Alcohols. N Engl J Med. 2018;378(3):270-80.
11. Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med. 2009;360(21):2216-23.
12. Kerns W 2nd, Tomaszewski C, McMartin K, Ford M, Brent J; META Study Group. Formate kinetics in methanol poisoning. J Toxicol Clin Toxicol. 2002;40(2):137-43.
13. Hovda KE, Froyshov S, Gudmundsdottir H, Rudberg N, Jacobsen D.. Fomepizole may change indication for hemodialysis in methanol poisoning: prospective study in seven cases. Clin Nephrol. 2005;64(3):190-7.
14. Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S,, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med. 2015;43(2):461-72.
15. Karlson-Stiber C, Persson H. Ethylene-glycol poisoning: experiences from an epidemic in Sweden. J Toxicol Clin Toxicol. 1992;30(4):565-74.
16. Winter M, Ellis M, Snodgrass W. Urine fluorescence using a Wood’s lamp to detect the antifreeze additive sodium fluorescein: A qualitative adjunctive test in suspected ethylene glycol ingestions. Ann Emerg Med. 1990;19(6):663-7.
17. Parsa T, Cunningham SJ, Wall SP, Almo SC, Crain EF. The usefulness of urine fluorescence for suspected antifreeze ingestion in children. Am J Emerg Med. 2005;23(6):787-92.
18. Wallace K, Suchard J, Curry S, Reagan C. Diagnostic use of physicians’ detection of urine fluorescence in a simulated ingestion of sodium fluorescein-containing antifreeze. Ann Emerg Med. 2001;38(1):49-54.
19. Grabow P, Clay K, Sullivan J, Lepoff R. Organic Acids in Ethylene Glycol intoxication. Ann Int Med. 1986;105:16-20.
20. Borron S, Megarbane B, Baud F. Fompeizole in the Treatment of uncomplicated ethylene glycol poisoning. Lancet. 1999;354(9181):831.
21. Boyer E, Mejia M, Woolf A, Shannon M. Severe ethylene glycol ingestion treated without hemodialysis. Pediatrics. 2001;107(1):172-3.
22. Megarbane B. Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open Access Emerg Med. 2010;2:67-75.
23. Porter W, Rutter P, Bush B, Pappas AA, Dunnington JE. Ethylene Glycol toxicity: the role of serum glycolic acid in hemodialysis. J Toxicol Clin Toxicol. 2001;39(6):607-15.
How to Cite
Gallagher N, Edwards F. The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Adv J Emerg Med. 3(3):e28.
Review article