Estimated Ethanol (and Toxic Alcohol) Serum Concentration Based on Ingestion
Allows estimation of maximal predicted serum concentration of alcohol based on volume and concentration ingested. Assumes 0.6 L/kg volume of distribution.
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.
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Amounts of alcohol ingested reported by history are often inaccurate (especially in children).
Recommendations for starting treatment:
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.
- 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.
[C] = Dose / (Vd × Weight); where:
- [C] is serum concentration (mg/L).
- Dose is amount ingested (mg).
- Vd is volume of distribution (L/kg).
- Weight is patient body weight (kg).
Example: a 3-year-old boy (15 kg) ingests 30 mL of windshield washer fluid (50% methanol). Maximal predicted serum methanol concentration:
- [C] = Dose / (Vd × Weight)
- 50% methanol = 50 g/100 mL = 500 mg/mL and
- 500 mg/mL × 30 mL ingested = 15,000 mg methanol
- [C] = 15,000 mg / (0.6 L/kg × 15 kg) = 1,667 mg/L
- 1,667 mg/L × 1 L/10 dL = 167 mg/dL
(a concentration requiring treatment with fomepizole)
Example: a 21-year-old man (70 kg) ingests 750 mL of 15% wine. Maximal predicted serum ethanol concentration:
- [C] = Dose / (Vd × Weight)
- 15% ethanol = 15 g/100 mL = 150 mg/mL and
- 150 mg/mL × 750 mL ingested = 112,500 mg ethanol
- [C] = 112,500 mg / (0.6 L/kg × 70 kg) = 2,679 mg/L
- 2,679 mg/L × 1 L/10 dL = 268 mg/dL
Facts & Figures
To convert mg/dL to mmol/L:
- Ethanol: divide ethanol concentration in mg/dL by 4.6
- Methanol: divide methanol concentration in mg/dL by 3.2
- Ethylene glycol: divide ethylene glycol concentration in mg/dL by 6.2
Original/Primary ReferenceYip L. Ethanol. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al, eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006.
About the Creator
Mary Ann Howland, PharmD, is an adjunct professor at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health and a clinical professor at the College of Pharmacy and Health Sciences at St. John's University. She specializes in clinical toxicology, poison control, and clinical toxicological management. Dr. Howland's work has been published in many books and journals, including Goldfrank's Toxicologic Emergencies.
To view Dr. Mary Ann Howland's publications, visit PubMed
- Scott Lucyk, MD
- Jonathan De Olano, MD