Abstract
Although alcohols share a common metabolic pathway, the toxicity of each is unique. This review discusses the common toxic alcohols, including ethanol, isopropanol, methanol, and ethylene glycol, and summarizes the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcome for each. A special consideration is also given to diethylene glycol due to its historical significance as a contaminant of multiple different drugs. Figures show type B lactic acidosis; the Mellanby effect; the role of thiamine in aerobic metabolism; the metabolism of isopropanol, methanol, formate, and ethylene glycol; and the relationship between the osmol gap and the anion gap over time. Tables list treatment recommendations for Wernicke encephalopathy, alcoholic ketoacidosis, and alcohol withdrawal; the Clinical Institute Withdrawal Assessment–Alcohol Revised (CIWA-Ar); dosing recommendations for fomepizole and ethanol; serum alkalization; and indications for hemodialysis in ethylene glycol poisoning. This review contains 8 figures, 10 tables, and 54 references. Keywords: Poisoning, ethanol, isopropanol, ethylene glycol, methanol, fomepizole, withdrawal, Wernicke encephalopathy, alcohol dehydrogenase, aldehyde dehydrogenase
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