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Toxicology – Isopropyl Alcohol (Isopropanol) Toxicity
Source
Isopropyl alcohol is commonly found in products such as rubbing alcohol, disinfectants, cleaning solutions, deicers, solvents, and certain fuel additives.
Typical Presentation
Patients often present with signs of significant intoxication, sometimes mistaken for ethanol ingestion. A distinguishing clue may be a fruity or acetone-like odor on the breath.
Clinical Features
This produces a hypnosedative toxidrome, often more intense than ethanol. Symptoms include slurred speech, impaired coordination, unsteady gait, nystagmus, confusion, and disinhibition. Severe cases may progress to hypotension, hypothermia, coma, and respiratory arrest.
Gastrointestinal irritation is prominent, with abdominal pain and possible hemorrhagic gastritis or esophagitis. Laboratory findings may show:
Mechanism of Action
Isopropanol acts as a central nervous system depressant via GABA receptor activity. It is metabolized by alcohol dehydrogenase into acetone, which is less toxic and responsible for the characteristic fruity odor.
Management
Treatment is primarily supportive:
Hemodialysis may be considered in severe cases, particularly when there is persistent coma or refractory hypotension. Unlike other toxic alcohols, antidotes such as fomepizole are not used because the metabolite (acetone) is not highly toxic.
Key Points
Source
Isopropyl alcohol is commonly found in products such as rubbing alcohol, disinfectants, cleaning solutions, deicers, solvents, and certain fuel additives.
Typical Presentation
Patients often present with signs of significant intoxication, sometimes mistaken for ethanol ingestion. A distinguishing clue may be a fruity or acetone-like odor on the breath.
Clinical Features
This produces a hypnosedative toxidrome, often more intense than ethanol. Symptoms include slurred speech, impaired coordination, unsteady gait, nystagmus, confusion, and disinhibition. Severe cases may progress to hypotension, hypothermia, coma, and respiratory arrest.
Gastrointestinal irritation is prominent, with abdominal pain and possible hemorrhagic gastritis or esophagitis. Laboratory findings may show:
- Increased osmolal gap
- Presence of ketones (without significant acidosis)
- Nongap metabolic acidosis
- Falsely elevated creatinine
Mechanism of Action
Isopropanol acts as a central nervous system depressant via GABA receptor activity. It is metabolized by alcohol dehydrogenase into acetone, which is less toxic and responsible for the characteristic fruity odor.
Management
Treatment is primarily supportive:
- Airway protection and monitoring
- Intravenous fluids for hypotension
- Vasopressors if needed
Hemodialysis may be considered in severe cases, particularly when there is persistent coma or refractory hypotension. Unlike other toxic alcohols, antidotes such as fomepizole are not used because the metabolite (acetone) is not highly toxic.
Key Points
- More potent intoxicant than ethanol.
- Causes ketosis without significant anion gap acidosis.
- Fruity breath odor is due to acetone formation.
- Management is usually supportive, with dialysis reserved for severe toxicity.
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