Isopropanol

CAS RN: 67-63-0

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Treatment is symptomatic and supportive care.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Treatment is symptomatic and supportive care. Critically ill patients will need emergent management of airway, breathing, and circulation. CNS depression may require intubation, and alcohol-induced vasodilation and vomiting may lead to hypotension requiring fluid resuscitation, and rarely vasopressors.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Do not administer prehospital activated charcoal, because of limited utility and the risk of aspiration if CNS depression develops. Irrigate exposed eyes with water. Wash exposed skin with soap and water and remove contaminated clothing.
    • 2) HOSPITAL: Activated charcoal and gastric lavage are not indicated. Consider simple nasogastric tube aspiration for large, recent ingestions if the airway is protected.
  • D) AIRWAY MANAGEMENT
    • 1) May be necessary after large ingestions if the patient's mental status is so depressed they cannot protect their airway.
  • E) ANTIDOTE
    • 1) No specific antidote is available.
  • F) ENHANCED ELIMINATION
    • 1) Hemodialysis could be considered in extreme cases; however, most patients should improve with supportive care. Dialysis should be considered when levels are extremely high (eg, greater than 500 to 600 mg/dL) or if hypotension does not respond to fluids and vasopressors.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Asymptomatic children (other than mild drowsiness) with an acute inadvertent ingestion may be monitored at home. Children younger than 6 years old who have ingested 30 mL or greater are more likely to become symptomatic and should be referred for evaluation and treatment.
    • 2) OBSERVATION CRITERIA: Patients with deliberate ingestions or any patient who manifests symptoms should be sent to a health care facility for observation until symptoms resolve.
    • 3) ADMISSION CRITERIA: Patients with significant persistent CNS toxicity (somnolence, intoxication, coma), hypotension or severe hemorrhagic gastritis should be admitted to an intensive care setting.
    • 4) CONSULT CRITERIA: Consult the poison center or medical toxicologist for assistance in managing patients with severe toxicity (eg, coma) or in whom the diagnosis is not clear.
  • H) PITFALLS
    • 1) Missing an ingestion of another toxic alcohol (eg, ethylene glycol, methanol) or other possible etiologies for a patient's symptoms. In cases of hemorrhagic gastritis, it is imperative the patient's hemoglobin is stable.
  • I) PHARMACOKINETICS
    • 1) Isopropanol is well absorbed by the body and quickly distributes into body fluids (volume of distribution 0.6 L/kg). It is metabolized by alcohol dehydrogenase to acetone (half-life of 2.5 to 3 hours).
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) CNS DEPRESSION: Other toxic alcohols, benzodiazepines, opiates/opiods, antipsychotic medications
    • 2) KETOSIS: Ethanol (alcoholic ketoacidosis), diabetic ketoacidosis, starvation ketosis.
      • a) Chronic ethanol abusers may present with alcoholic ketoacidosis after a sudden reduction of caloric intake. Patients with alcoholic ketoacidosis and isopropyl alcohol intoxication may be misdiagnosed with ethanol, methanol, or ethylene glycol intoxication.
    • 3) GASTRITIS: Nonsteroidal anti-inflammatories, heavy metals
0.4.3 INHALATION EXPOSURE
  • A) Supportive care.
0.4.4 EYE EXPOSURE
  • A) Irrigate with water or normal saline, slit lamp examination if irritation persists.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) Wash exposed skin with soap and water and remove contaminated clothing. Supportive care.
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