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- alcohol legal limit
- 80mg%
- toxic signs and symptoms of methanol and ethylene glycol
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1)MeOH -> formic acid = retinal damage-blindness)
2)EG -> oxalate = calcium oxalate crystals in urine -> precipitates in kidney = ARF -> decreased Ca++ - why is it important to understand the metabolism of methanol and ethylene glycol?
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1)parent compounds are not as toxic as the metabolites
2)metabolism takes time to occur so be aware of delay in toxic sxs (pts may initially appear non-toxic and diagnosis needs to be based on suspicion) - metabolism products of methanol and ethylene glycol
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methanol -> formaldehyde + formic acid
ethylene glycol -> glyoxalate
both products are acidic - how is ethanol eliminated?
- high affinity for alcohol dehydrogenase (easily saturated) so becomes zero-order rate of elimination (constant amount eliminated per time)
- rate of alcohol eliminatino in non-alcoholics and alcoholics
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1)non-alcoholics = 15-25mg%/hr
2)alcoholics = 2x NL (30-50mg%/hr) - besides serum drug levels, what are four other labs or tests that are useful in determining whether or not an alcohol other than ethanol is involved in this case or not?
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1)ABG (confirm metabolic acidosis)
2)OSMOLAR GAP (must be run by freezing point depression method-or falsely low due to alcohol evaporation w/ vapor pressure method)
3)LOOK AT URINE UNDER WOOD'S LAMP (fluroscein dye in some antifreezes is fluroescent (EG)
4)LOOK AT URINE UNDER MICROSCOPE (calcium oxalate crystals = EG)
5)SERUM CALCIUM LEVEL decreased in EG - how do you calculate osmolar gap?
- 1)measured OSM - calculated OSM = OSM Gap (>10 is abnormal)
- what is the formula for calculated OSM?
- 2[Na+] + GLC/18 + BUN/3 + EtOH/5
- how can there be an elevated osmolar gap without a signicant metabolic acidosis?
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1)parent compounds are osmotically active and metolism has not occurred to a significant degree yet in order to produce acidic metabolites
2)EtOH is causing a delay in the metabolism of the EG and MeOH preventing the formation of the acidic metabolites - how do you treat toxic alcohol intoxication
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1)EtOH drip 5-10% IV
LD=0.8g/kg or 3-4shots of 80 proof
MD=130mg/kg/hr -> increase rate with HD
2)Folic acid 50-75mg IV q4hr
3)pyridoxine 50mg IV q6hr
4)thiamine 100mg IV q6hr - what is the mechanism of action of EtOH drip, folic acid, and pyridoxine in alcohol intoxication?
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1)EtOH prevents formation of acidic metabolites since it is preferred by alcohol dehydrogenase
2)folic acid = formic -> CO2 + H20
3)pyridoxine = glyoxylate -> glycine - when is hemodialysis indicated for methanol and ethylene glycol intoxications?
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1)[MeOH] or [EG] > 25mg/dL
2)worsening acidosis w/ any level (repeat blood gases or increased anion gap progressively)
3)visual changes or other severe sxs
4)renal failure