REBEL Cast REBEL Core Cast 128.0 – Toxic Alcohols
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Oct 2, 2024 Sanjay Mohan, an in-house toxicologist, dives into the perilous world of toxic alcohols like methanol and ethylene glycol. He discusses how these substances can present symptoms mimicking ethanol intoxication, complicating diagnosis. The conversation highlights key diagnostic challenges, stressing that a normal osmolar gap doesn't rule out ingestion. Mohan also covers critical management strategies, including the use of fomepizole and the importance of early intervention, particularly in cases of severe metabolic acidosis or renal dysfunction.
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Pathophysiology of Toxic Alcohols
- Methanol and ethylene glycol parent alcohols cause elevated osmolar gap early after ingestion.
- Their toxic metabolites cause anion gap metabolic acidosis and organ damage later on.
Presentation Timing Challenges
- Early after ingestion, toxic alcohol intoxication looks identical to ethanol intoxication.
- Toxic metabolites cause later end-organ damage like blindness from methanol or kidney failure from ethylene glycol.
Lab Evaluation for Toxic Alcohols
- When evaluating suspected toxic alcohol ingestion, order chemistry panel, blood gas, ethanol level, and measured serum osmolality.
- Calculate osmolar gap to detect presence of parent toxic alcohols early.
Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage.