Isopropanol Intoxication

Isopropanol is found in disinfectants, household cleaning products, cosmetics, and most commonly in rubbing alcohol at a 70% concentration. Routes of intoxication include inhalation of high concentrations and accidental or intentional ingestion. A fatal Isopropanol intoxication in adults is quite rare.  Although, it should be considered potentially toxic when ingested by any pediatric patient.

Within 30 minutes of ingestion the product is usually completely absorbed and can lead to CNS depression as well as respiratory compromise. Other symptoms include GI bleeds accompanied with hematemesis, abdominal pain and gastritis. When ingested or inhaled in high concentrations, isopropanol will be metabolized into acetate among other metabolites. These other metabolites will turn into glucose and other products. Acetone as well as isopropanol particles will be present in the blood after intoxication. Diagnosis will be based on patient’s history and overall clinical presentation.

Excretion of isopropanol is mainly renal and respiratory. Clinical signs for diagnosis include acetone breath (fruity/ sweet odor), osmol gap, ketonemia and ketonuria measured through blood and urine tests.

In the field, care for intoxicated patients is mainly supportive. ABC’s are always a priority. In the case of respiratory distress, airway management such as intubation may be necessary. Ventilatory and circulatory support may also be indicated. Depending on the quality and quantity/min of the patient’s respirations. The patient’s BP and heart rate as well as the presence of radial pulses can also indicate the need for further treatment. Therefore, assisted respirations as well as fluid resuscitation may be initiated.

Signs of shock could also indicate the need for support:

• Diaphoresis

• Hypotension

• Altered mental status

• Agitation and anxiety

• Decreased skin temperature

• Pale skin

• Tachycardia

• Tachypnea

• Nausea or vomiting

• Pupil dilation

• Weakness or fatigue

• Syncope or quasi-syncope

For patients with severe intoxications, in respiratory/circulatory collapse, hemodialysis may be necessary in order to enhance the elimination of isopropanol and acetate that has been absorbed into the circulatory system. It is to be noted that in adult patients,

the elimination half-life of isopropanol is between 2.5 and 8.0 h, whereas elimination of acetone is slower with a half-life following isopropanol ingestion of between 7.7 and 27 h. (1) 

Moreover, the time it takes for the patient to actually eliminate this toxic product and its metabolites may be reduced with hemodialysis.

(1)  from https://www.ncbi.nlm.nih.gov/pubmed/24815348

Isopropanol is more toxic than the metabolites it breaks down to. Ethanol administration which inhibits the ADH (alcohol dehydrogenase) enzyme will thus prevent isopropanol from breaking down and should not be administered if isopropanol intoxication is suspected. Isopropanol is contrary to methanol or ethylene glycol as their metabolites are much more dangerous than the products themselves thus ethanol is indicated.

Slaughter, R. J., Mason, R. W., Beasley, D. M., Vale, J. A., & Schep, L. J. (2014, June). Isopropanol poisoning. Retrieved September 10, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/24815348

Emandi, A., & Coberly, L. (2007, February 1). Intoxication of a Hospitalized Patient with an Isopropanol-Based Hand Sanitizer — NEJM. Retrieved September 13, 2017, from http://www.nejm.org/doi/full/10.1056/NEJMc063237#t=article

Burns, E., & Thorisson, D. (2016, May 18). Toxic Alcohol Ingestion. Retrieved September 13, 2017, from https://lifeinthefastlane.com/toxic-alcohol-ingestion/

Wood, J. N., Carney, J., Szczepanski, K., Calello, D. P., & Hurt, H. (2007, March 01). Transplacental isopropanol exposure: case report and review of metabolic principles. Retrieved September 13, 2017, from http://www.nature.com/jp/journal/v27/n3/full/7211646a.html?foxtrotcallback=true

Sanders, M. J. (2015). Mosbys paramedic textbook (4th ed.). St-Louis, MI: Jones & Bartlett Learning.