Pediatric emergency medicine trisk 3096 3096
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concentrations, the longer the elimination process because the capacity of the
body to produce alcohol dehydrogenase is limited. The rate of reduction in blood
alcohol concentration varies from 10 to 25 mg/dL/hr. Although hemodialysis
effectively enhances elimination by three- to fourfold, it is rarely necessary. The
institution of hemodialysis may be useful in those patients who have impaired
liver function or a blood alcohol concentration higher than 450 to 500 mg/dL.
Isopropyl Alcohol
Poisoning with isopropyl alcohol may be particularly insidious because oral
ingestion is not the only route of exposure. Children may develop severe
intoxication, including coma, after topical application of isopropyl alcohol for the
relief of fever (although such exposure may represent inhalational exposure rather
than direct, dermal absorption). Because isopropyl alcohol is usually available in
a 70% concentration by volume, ingestion of 2 to 2.5 mL/kg of this solution may
lead to symptoms. Ingestion causes many of the same features as ethanol
ingestion, with the additional complication of severe gastritis. Unlike the other
toxic alcohols, isopropyl alcohol does not lead to metabolic acidosis. This is
because its metabolite, acetone, is not an acid. However, it is approximately twice
as intoxicating as ethanol, leading to greater mental status impairment at
comparable serum levels. At high serum levels, isopropyl alcohol causes direct
myocardial depression, which may be life threatening.
