Toxic Alcohols - Dr. Snow

• ​Always include toxic alcohols in your differential of anion gap metabolic acidosis.
• K.I.L.R for acidosis: Ketoacids, Ingestion, Lactate, Renal 
• Toxic alcohols in 3 easy steps: R.B.D. = Recognize the diagnosis, Block ADH, Dialysis when needed
• Know how to calculate the osmolar gap  (Measured osm - Calculated osm)
• Calculated osm = 2xNa + BUN/2.8 + Glucose/18 + ETOH/4.6
• Must be drawn at same time as BMP
• Do not wait on alcohol levels to institute alcohol dehydrogenase blocking therapy
• Ethanol and Fomepizole appear to be equally efficacious as antidotes.  However, ethanol infusions have a much higher adverse event rate.
• Ketosis/ketouria, osm gap, withOUT metabolic acidosis = isopropyl alcohol
• High dose lorazepam or diazepam infusions: remember propylene glycol——lactic acid can produce acidosis.

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