Views: 0 Author: Site Editor Publish Time: 2022-06-15 Origin: Site
The following tests should be available in all poisoned patients:
● Finger blood sugar, exclude hypoglycemia is the cause of mental state change
● Acetaminophen and salicylic acid levels to exclude these common combinations
● Electrocardiogram (ECG) can rule out conduction system poisoning caused by drugs affecting QRS or QTc interphase
Pregnancy tests for women of childbearing age
Serum isopropanol and acetone levels:
Serum concentrations of isopropanol and acetone can be directly quantified using gas chromatography. The primary use of this test is to confirm the diagnosis, as the treatment is largely supportive. But the law is not widespread. If there is uncertainty about the cause of the patient's altered mental state and in the presence of another toxic alcohol, it is important to confirm the diagnosis. A serum concentration of at least 100 mg/dL (17 mmol/L) is required to cause a decreased level of consciousness. Due to the endogenous reduction of acetone to isopropyl alcohol, low concentrations of isopropyl alcohol may be detected in the serum of patients with severe diabetes or alcoholic ketoacidosis, and even mortality may be incorrectly associated with isopropyl alcohol exposure.
Differential osmotic pressure can provide important diagnostic information when quantitative serum tests for toxic alcohols are not readily available. By comparing measured plasma osmotic pressure with calculated values, the clinician can infer the presence of an electrically neutral substance with osmotic activity at a serum concentration higher than 10mmol/L (at least 60mg/dL). Both isopropanol and acetone increase the osmotic pressure difference. Plasma oerpressure gaps do not distinguish isopropyl alcohol, methanol, and ethylene glycol poisoning and therefore cannot be used to exclude diagnosis. Unlike methanol and glycol poisoning, neither metabolic acidosis nor anion gap is expected to increase after isopropanol ingestion.
Serum and urine ketones:
Low concentrations of serum ketone bodies do not suggest isopropyl alcohol exposure, especially when β -hydroxybutyric acid concentration is measured. Acetone is the main ketone produced by isopropanol metabolism. Even after large intake, the serum β -hydroxybutyric acid concentration is still very low. Acetone concentration > 100 mg/dL may increase serum creatinine.
If the patient does not steadily improve over several hours of observation, other causes of the disorder must be sought. Additional tests such as head CT, lumbar puncture and creatine kinase may be required.
Beginning with assessment and stabilization of airway, respiration, and circulation, advanced cardiac life support measures must be provided. If there is doubt about the patient's ability to protect the airway and avoid aspiration, the clinician should consider endotracheal intubation.
Observe closely for signs of poisoning (e.g., numbness, hypotension) and establish intravenous access. Intraenous crystals are usually sufficient to correct any hypotension caused by vasodilation and occasionally vasopressors are required. Hypoglycemia should be corrected. As with alcohol overdose, most patients with symptoms recover within hours of ingestion.
Gastrointestinal decontamination is ineffective in the vast majority of isolated isopropyl alcohol poisoning cases. The rapid absorption and low toxicity of oral ingestion make this intervention unnecessary. If this can be done within an hour of mass ingestion, gastrointestinal decompression may be considered as it reduces the duration of coma, but this is not a key intervention.
Ethanol dehydrogenase (ADH) inhibition: Since acetone is less toxic than isopropyl alcohol, there is no indication of ADH inhibition by aspirin or ethanol after isopropyl alcohol exposure.
Large intake: In rare patients with large intentional intake, hemodynamically unstable patients should be treated with vasoactive drugs. The serum isopropyl alcohol concentration in such patients usually exceeds 500 mg/dL (80 mmol/L), and the plasma osmotic pressure difference generally exceeds 100 mosmol/L.
Patients who remain hemodynamically unstable after aggressive fluid resuscitation should be considered for hemodialysis. It should be emphasized, however, that hemodialysis is rarely required and the risks outweigh the benefits.
In patients who ingest isopropyl alcohol quickly and unintentionally, symptoms often develop quickly. If isopropyl alcohol is known to be the only ingested substance, discharge may occur 2 hours after symptoms subside. Patients who consume alcohol recreationally or as an ethanol substitute should assess their intake and manage it accordingly. Intentional ingestion may cause harm.