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HIGH-YIELD FACTS

  • Ethanol overdose in children may result in altered mental status and hypoglycemia.

  • Methanol poisoning is manifested by metabolic acidosis, visual disturbance, and potential multiorgan system failure.

  • Ethylene glycol poisoning is manifested by metabolic acidosis, renal failure, and potential multiorgan system failure.

  • Isopropanol may cause central nervous system (CNS) depression and hypotension but does not cause metabolic acidosis.

  • All alcohols can produce an osmolar gap but the absence of an osmolar gap does not exclude a toxic alcohol ingestion.

  • Fomepizole is the only Food and Drug Administration (FDA)-approved antidote for ethylene glycol and methanol poisoning, and it should be initiated if there is strong clinical concern for ingestion of a toxic dose of these two poisons.

  • Hemodialysis is indicated for toxic alcohol poisoning not responsive to supportive and antidote therapy or in patients with evidence of end-organ damage or severe acidosis.

ETHANOL

Ethanol is consumed on a daily basis worldwide, and regardless of country of origin, it is a common problem among children and adolescents. In China, high school pooled male drinking rate in a recent meta-analysis was 36.5%, while middle school male drinking rate was 23.6% over 30 days.1 In East Africa, the prevalence of alcohol use in secondary school students was 33%, with problem drinking ranging from 3 to 15%.2 According to a 2-year prospective study in Norway, 46% of poisonings in 8- to 15-year-old children involved ethanol.3 In the Slovak Republic, ethanol accounted for 34% of all intoxications in children 9 to 18 years old, and the proportion of children admitted for ethanol intoxication increased yearly over 10 years.4 In the United States, alcohol is the recreational substance most commonly used by youth. “Binge drinking” tendencies (five or more consecutive drinks on one occasion) have been reported in 4% to 17% of 8th through 12th graders, respectively, and up to 32% of college students.5 Intermittent ethanol exposure in adolescence is associated with lasting changes in the adult brain that can increase the risk for alcohol use disorder and dependence as well as all the complications of alcoholism.6

PHARMACOKINETICS AND PATHOPHYSIOLOGY

Ethanol undergoes hepatic metabolism via two metabolic pathways: alcohol dehydrogenase and the microsomal ethanol oxidizing system (MEOS). Alcohol dehydrogenase (ADH) is the major metabolic pathway and the rate-limiting step in converting ethanol to acetaldehyde. Acetaldehyde is then metabolized by aldehyde dehydrogenase (ALDH) into acetic acid, which is then converted to water and carbon dioxide. With consumption of large quantities of ethanol, the cytochrome P450 2E1 enzyme contributes to ethanol metabolism. In general, non-tolerant individuals metabolize ethanol at 10 to 25 mg/dL/h, and those with tolerance can metabolize it up to a rate of 30 mg/dL/h.7 Children may ingest large amounts of ethanol in relation to their body weight, resulting in rapid development of high blood concentrations. In children younger than 5 years, the ability to metabolize ethanol is ...

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