MDCalc

Estimated Ethanol (and Toxic Alcohol) Serum Concentration Based on Ingestion

Predicts ethanol concentration based on ingestion of alcohol.

Allows estimation of maximal predicted serum concentration of alcohol based on volume and concentration ingested. Assumes 0.6 L/kg volume of distribution.

%
mL
Type of alcohol

Result:

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Advice

Amounts of alcohol ingested reported by history are often inaccurate (especially in children).

Management

Recommendations for starting treatment:

Overdose

Treatment

Methanol
  • Concentration ≥20 mg/dL (6.2 mmol/L), OR
  • Documented recent history of ingestion and osmolal gap >10 mOsm/L, OR
  • Suspected methanol ingestion and at least two of the following: arterial pH <7.3, serum carbon dioxide level <20 mmol/L, and osmolal gap >10 mOsm/L.

Ethylene glycol
  • Concentration ≥20 mg/dL (3.2 mmol/L), OR
  • Documented history of ingestion an osmolal gap >10 mOsm/L, OR
  • Suspected ethylene glycol ingestion and at least three of the following: arterial pH <7.3, serum carbon dioxide level <20 mmol/L, osmolal gap >10 mOsm/L, and oxalate crystalluria.

Diethylene glycol

Immediate treatment recommended for any history of diethylene glycol ingestion.

Isopropyl alcohol and propylene glycol

No recommendations for treating with fomepizole, as it would prolong the symptoms of intoxication. The treatment is supportive for both and neither is generally toxic unless massive ingestions requiring vasopressor support.

From Brent 2009.

Critical Actions
  • Seemingly small ingestions of alcohols can lead to significant serum concentrations (i.e., methanol/ethylene glycol concentrations that require treatment with fomepizole).
  • Toxic alcohols (methanol, ethylene glycol) have different concentrations depending on the product. Concentration of the ingested product must be known in order to estimate serum concentration.
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