Alcohol intoxication

Ethylene glycol

 * A colorless syrupy liquid with a sweet taste and is used to make antifreeze products (Fridex® for car radiators, brake fluid).

Etiopathogenesis

 * By the same enzymes as alcohol, it is biotransformed → into glycoaldehyde → oxalic acid ,
 * damages renal tubules by forming calcium oxalate crystals → acute renal failure and MAC ,
 * osmolarity rises significantly,
 * the maximum concentration in plasma is 1–4 h after ingestion, the elimination half-life is short,
 * lethal dose - about 100 ml (with timely treatment, the ingestion of 2 liters was also survived).

Clinical picture

 * 1) Neurotoxic stage – transient drunkenness, vomiting, drowsiness, then development of MAC , hyperosmolarity, convulsions, convulsions, coma (secondary brain edema).
 * 2) Kardiopulmonální stádium – zin 12–24 h, dysrhythmia, severe acidosis, hyperventilation ( Kussmaul breathing ), circulatory collapse, hypocalcemia → convulsions, edema of lungs, brain, cardiopulmonary arrest.
 * 3) Renal stage – 24–72 h – hematuria, albuminuria , oliguria , oxaluria , acute tubular necrosis , anuria , renal function never returns to normal.

Treatment

 * The antidote is ethanol - orally or in a 5% glucose infusion, the level is maintained at 1 per thousand . Ethanol has a 100x greater affinity for alcohol dehydrogenase, unconverted ethylene glycol is then excreted in the urine,
 * dwe also administer vitamin B 1 and folic acid ,
 * possibly hemodialysis ,
 * ideal drug – fomepizole ( Antizol® ) – alcohol dehydrogenase inhibitor – very expensive.

Methyl alcohol



 * Formerly "wood spirit", most often mistaken for alcohol,
 * it is well absorbed by the lungs and skin (it is also possible to become intoxicated),
 * 30–60% is exhaled unchanged through the lungs, the rest is oxidized to formaldehyde and formic acid,
 * folic acid is involved in the metabolism of formic acid, its decomposition is slow, there is a risk of accumulation, there is a risk of severe MAC and vision damage ,
 * vision disorders – up to 24 h latency - initially blurred vision, flashes of light, feelings of glare, loss of field of vision, fundus - there is hyperemia and edema in the disc, in addition to the nerve , it damages the retina by blocking cytochrome oxidase → hypoxia ,
 * blindness – 15 ml each
 * death – 30-240 ml each

Treatment

 * As in ethylene glycol.

Investigation

 * Methanol in the urine ( BET ), in the case of intoxication in the blood, it is more reliable to measure formic acid in the urine (as a metabolite), but this is not usually done.

Source
BENEŠ, Jiří. Study materials [online]. [feeling. 24/02/2010]. < http://jirben.wz.cz >.