Isopropyl alcohol poisoning
- Marco L A Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
Marco L A Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
- Associate Professor of Emergency Medicine and of Pharmacology and Toxicology
- Queen's University, Kingston Canada
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
Isopropyl alcohol (isopropanol, 2-propanol, propan-2-ol) is commonly used as a disinfectant, antifreeze, and solvent, and typically comprises 70 percent of "rubbing alcohol." People ingest isopropyl alcohol to become intoxicated (ie, ethanol substitute) or to harm themselves. When ingested, isopropyl alcohol functions primarily as a central nervous system (CNS) inebriant and depressant, and its toxicity and treatment resemble that of ethanol.
Fatality from isolated isopropyl alcohol toxicity is rare, but can result from injury due to inebriant effects, untreated coma with airway compromise, or rarely, cardiovascular depression and shock following massive ingestion. Supportive care can avert most morbidity and mortality. It is important to differentiate isopropyl alcohol poisoning from methanol and ethylene glycol, which are more dangerous. Isopropyl alcohol does NOT cause an elevated anion gap acidosis, retinal toxicity (as does methanol), or renal failure (as does ethylene glycol). (See 'Differential diagnosis' below.).
This topic review will discuss the diagnosis and management of isopropyl alcohol intoxication. A summary table to facilitate emergency management is provided (table 1). Discussions of other toxic alcohols and a general approach to the poisoned patient are found elsewhere. (See "Ethanol intoxication in adults" and "Methanol and ethylene glycol poisoning" and "General approach to drug poisoning in adults" and "Approach to the child with occult toxic exposure".)
PHARMACOLOGY AND TOXICOLOGY
Isopropyl alcohol is a sedative-hypnotic agent whose toxicity closely resembles that of ethanol, with which it shares strong structural similarity. Like ethanol, isopropyl alcohol's precise mechanism of action in the central nervous system (CNS) remains uncertain. Changes in membrane fluidity and/or function, and interactions with neurotransmitter receptors, are believed to account for the CNS effects of alcohols and other simple hydrocarbons. There is a linear relationship between the molecular weight of alcohols and their sedative effects: as size increases so does sedation. Thus, isopropyl alcohol is marginally more potent than ethanol at comparable concentrations.
In untreated animals, the median lethal dose lies between 4 and 8 g/kg. Many sources estimate the lethal dose to be 250 mL in humans (eg, less than 400 mL of a 70 percent solution). It is important to recognize that, with treatment, adults and children have survived much larger ingestions [1,2].
- Trullas JC, Aguilo S, Castro P, Nogue S. Life-threatening isopropyl alcohol intoxication: is hemodialysis really necessary? Vet Hum Toxicol 2004; 46:282.
- Freireich AW, Cinque TJ, Xanthaky G, Landau D. Hemodialysis for isopropanol poisoning. N Engl J Med 1967; 277:699.
- Lacouture PG, Heldreth DD, Shannon M, Lovejoy FH Jr. The generation of acetonemia/acetonuria following ingestion of a subtoxic dose of isopropyl alcohol. Am J Emerg Med 1989; 7:38.
- Stremski E, Hennes H. Accidental isopropanol ingestion in children. Pediatr Emerg Care 2000; 16:238.
- Leeper SC, Almatari AL, Ingram JD, Ferslew KE. Topical absorption of isopropyl alcohol induced cardiac and neurologic deficits in an adult female with intact skin. Vet Hum Toxicol 2000; 42:15.
- Vivier PM, Lewander WJ, Martin HF, Linakis JG. Isopropyl alcohol intoxication in a neonate through chronic dermal exposure: a complication of a culturally-based umbilical care practice. Pediatr Emerg Care 1994; 10:91.
- Mydler TT, Wasserman GS, Watson WA, Knapp JF. Two-week-old infant with isopropanol intoxication. Pediatr Emerg Care 1993; 9:146.
- Monaghan MS, Ackerman BH, Olsen KM, et al. The use of delta osmolality to predict serum isopropanol and acetone concentrations. Pharmacotherapy 1993; 13:60.
- Pappas AA, Ackerman BH, Olsen KM, Taylor EH. Isopropanol ingestion: a report of six episodes with isopropanol and acetone serum concentration time data. J Toxicol Clin Toxicol 1991; 29:11.
- Gaudet MP, Fraser GL. Isopropanol ingestion: case report with pharmacokinetic analysis. Am J Emerg Med 1989; 7:297.
- Natowicz M, Donahue J, Gorman L, et al. Pharmacokinetic analysis of a case of isopropanol intoxication. Clin Chem 1985; 31:326.
- Jones AW. Elimination half-life of acetone in humans: case reports and review of the literature. J Anal Toxicol 2000; 24:8.
- Parker KM, Lera TA Jr. Acute isopropanol ingestion: pharmacokinetic parameters in the infant. Am J Emerg Med 1992; 10:542.
- Bekka R, Borron SW, Astier A, et al. Treatment of methanol and isopropanol poisoning with intravenous fomepizole. J Toxicol Clin Toxicol 2001; 39:59.
- Rosansky SJ. Isopropyl alcohol poisoning treated with hemodialysis: kinetics of isopropyl alcohol and acetone removal. J Toxicol Clin Toxicol 1982; 19:265.
- Abramson S, Singh AK. Treatment of the alcohol intoxications: ethylene glycol, methanol and isopropanol. Curr Opin Nephrol Hypertens 2000; 9:695.
- Jones AE, Summers RL. Detection of isopropyl alcohol in a patient with diabetic ketoacidosis. J Emerg Med 2000; 19:165.
- Bailey DN. Detection of isopropanol in acetonemic patients not exposed to isopropanol. J Toxicol Clin Toxicol 1990; 28:459.
- Blijenberg BG, Brouwer HJ. The accuracy of creatinine methods based on the Jaffé reaction: a questionable matter. Eur J Clin Chem Clin Biochem 1994; 32:909.
- Linden CH. Unknown alcohol. Ann Emerg Med 1996; 28:371.
- Zaman F, Pervez A, Abreo K. Isopropyl alcohol intoxication: a diagnostic challenge. Am J Kidney Dis 2002; 40:E12.
- Burkhart KK, Martinez MA. The adsorption of isopropanol and acetone by activated charcoal. J Toxicol Clin Toxicol 1992; 30:371.
- Su M, Hoffman RS, Nelson LS. Error in an emergency medicine textbook: isopropyl alcohol toxicity. Acad Emerg Med 2002; 9:175.
- PHARMACOLOGY AND TOXICOLOGY
- CLINICAL FEATURES OF OVERDOSE
- Major effect and clinical course
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- Tests to obtain
- Serum isopropyl alcohol and acetone levels
- Osmolal gap
- Serum and urine ketones
- Additional tests
- Alcohol dehydrogenase (ADH) inhibition
- Massive ingestion
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS