Propargyl Alcohol

CAS RN:107-19-7

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) The mainstay of management of mild to moderate toxicity is removal/decontamination and supportive care. Gastrointestinal symptoms can be treated with antiemetics and fluid hydration.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) For severe toxicity, treatment should be targeted towards symptoms. Hypotensive patients should be given boluses of isotonic fluids and pressors as necessary. Patients with severe respiratory symptoms may required intubation, and if acute lung injury develops, ventilation with small tidal volumes (6 mL/kg). Antibiotics should only be given when there is evidence of infection. Hemodialysis should be performed in patients with severe toxicity not responding to supportive care.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: GI decontamination is not indicated. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate exposed eyes.
    • 2) HOSPITAL: GI decontamination is not indicated. Orogastric aspiration can be considered for large or massive ingestions that have occurred recently. Remove contaminated clothing and wash exposed skin with soap and water. Irrigate exposed eyes.
  • D) ANTIDOTE
    • 1) None.
  • E) ENHANCED ELIMINATION PROCEDURE
    • 1) Severely toxic patients (eg, patients with coma, severe metabolic acidosis) may benefit from hemodialysis to remove unmetabolized alcohols or toxic metabolites.
  • F) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Older children or adults with small unintentional ingestions with minimal to no symptoms may be managed at home.
    • 2) OBSERVATION CRITERIA: Patients should be sent to a healthcare facility if their exposure to higher alcohols was in a self-harm attempt, involved a large volume or if they are symptomatic. They should be observed for 4 to 6 hours and be clearly improving or asymptomatic prior to discharge. In young children, minimal exposures can be symptomatic so any such exposures should be sent in for observation and lab work.
    • 3) ADMISSION CRITERIA: Patients with severe symptoms or those getting worse after an observation period of 4 to 6 hours should be admitted to the hospital. Depending on the severity of their symptoms, ICU admission may be warranted (eg, intubated patients). Patients should not be discharged until they are clearly improving or asymptomatic.
    • 4) CONSULT CRITERIA: Consultation with critical care specialists may be required for patients in the ICU. Nephrologists may be needed for consultation for potential dialysis. Consult a clinical toxicologist or poison center for patients with large ingestions, severe symptoms or if the diagnosis is unclear.
  • G) PITFALLS
    • 1) Potential errors in management include confusing higher alcohols with other alcohols and not recognizing the potential for severe symptoms.
  • H) TOXICOKINETICS
    • 1) As with other alcohols, absorption from the gastrointestinal tract appears to be rapid and efficient. Dermal penetration of higher alcohols does not occur as readily as with smaller molecular weight alcohols. Absorption from inhalation is limited and higher chain alcohols are less likely to be inhaled. Primary alcohols are metabolized by alcohol dehydrogenase to corresponding aldehydes and then by aldehyde dehydrogenase to acids. Secondary and tertiary alcohols are eliminated by conjugation with glucuronides. Overall elimination is slower and effects are therefore prolonged. If ketones are formed as metabolites, they may act as sedatives. Many high alcohols and their metabolites are excreted in the urine though some can be excreted in the lungs and feces. Higher alcohols are not bound by proteins and administration of other alcohols may affect metabolism kinetics.
  • I) PREDISPOSING CONDITIONS
    • 1) Patients at extremes of age may be more sensitive to symptoms. Patients with liver and renal disease may be more sensitive to toxicity as well.
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) Ingestion of other alcohols may have some similar features, and ingestion of other substances that can cause CNS depression could be initially confused for ingestion of higher alcohols.
0.4.3 INHALATION EXPOSURE
  • A) SUMMARY: For inhalational exposures, remove the patient to fresh air and give supplemental oxygen and assisted ventilation as needed. If bronchospasm develops, treat with inhaled beta adrenergic agonists.
  • B) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
0.4.4 EYE EXPOSURE
  • A) Remove contact lenses and irrigate eyes with water for at least 15 minutes.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Remove contaminated clothing and wash exposed areas thoroughly with soap and water.
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