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    Patent Pending

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

    Predicts ethanol concentration based on ingestion of alcohol.
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    INSTRUCTIONS

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

    When to Use
    Pearls/Pitfalls
    Why Use

    Predicting serum concentration of toxic alcohols.

    • The formula makes several assumptions to approximate maximal predicted serum concentration:
      • Complete alcohol absorption.
      • Absence of alcohol metabolism or elimination.
      • Absence of volume contraction effects.
      • Alcohol specific gravity disregarded.
      • Gender and age differences in pharmacokinetics discounted.
    • The estimated serum concentration from ingestion of a given volume of alcohol will differ depending on which alcohol is ingested.

    Estimates maximal predicted serum concentration of alcohol based on volume and concentration ingested.

    lbs
    %
    mL
    Ethanol
    Methanol
    Ethylene glycol
    Diethylene glycol

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.
    Content Contributors
    About the Creator
    Dr. Mary Ann Howland
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