Isopropyl alcohol is commonly used as a disinfectant, hand sanitizer, antifreeze, and solvent, and typically comprises 70 percent of “rubbing alcohol” (Sivilotti, 2021). People ingest isopropyl alcohol either unintentionally or with the intent to become intoxicated, such as ethanol substitute, or to harm themselves. Isopropyl alcohol functions primarily as a CNS inebriant and depressant, and its toxicity and treatment resemble those of ethanol(Sivilotti, 2021). Ashurst and Nappe (2021) wrote that on physical examination, isopropyl intoxication mimics ethanol intoxication. Isopropyl alcohol can produce an altered sensorium, hypotension, hypothermia, and even cardiopulmonary collapse. Acetone can contribute to CNS depression. On pupillary examination, miosis is the most common finding. Patients also may experience a loss of deep tendon and corneal reflexes and may experience an extensor reaction to plantar reflex testing. Other symptoms include gastric issues, including pain, vomiting, and severe gastritis with hematemesis. The clinical diagnosis of isopropyl alcohol toxicity should be suspected with a history of ingestion, elevated osmolar gap, absence of a significant anion gap, and the typical smell of isopropanol or acetone(Perri et al., n.d.). Ketones may be detected in blood and urine within 3 hours from ingestion(Perri et al., n.d.). Differential diagnosis may include methanol or ethylene glycol ingestion. Starvation, alcoholic, and diabetic forms of ketoacidosis can also present with depressed mental status and ketosis(Sivilotti, 2021). For treatment, decontamination with activated charcoal can only benefit if large ingestions present within 20-30 minutes of ingestion due to isopropyl alcohol being rapidly absorbed(Perri et al., n.d.). There is no antidote for this; however, supportive care such as ensuring airway patency, assisting ventilation if necessary, and fluid resuscitation or vasopressors for hypotension. Hemodialysis is rarely required and reserved for massive ingestions(Perri et al., n.d.).
Ashurst, J. V., & Nappe, T. M. (2021, June 26). Isopropanolol toxicity. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493181/
Perri, D., Klimaszyk, D., Kolacinski, Z., & Szajewski, J. (n.d.). Isopropyl alcohol. In D. Perri & D. Klimaszyk (Eds.), McMaster Textbook of Internal Medicine. https://empendium.com/mcmtextbook/chapter/B31.II.20.2.4.
Sivilotti, M. L. A. (2021, May 27). Isopropyl alcohol poisoning. UpToDate. https://www.uptodate.com/contents/isopropyl-alcohol-poisoning?source=history_widget
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