SAQ 342 – Toxicology – toxic alcohol poisoning and severe acidosis

Toxicology – toxic alcohol poisoning and severe acidosis.

a. VBG interpretation

• Profound acidaemia, pH 7.09.
• Raised anion-gap metabolic acidosis with bicarbonate 7; differentials include lactataemia, ketoacidosis, and toxic alcohol.
• Anion gap is approximately 29: Na – (Cl + HCO3) = 134 – (98 + 7).
• Delta ratio is approximately 1.
• Additional respiratory acidosis: measured pCO2 is 18, with expected pCO2 lower for compensation.
• Corrected potassium is approximately 3.2 mmol/L.
• Raised osmolar gap, approximately 23.
• Oxygenation cannot be assessed reliably on a venous gas.

b. Diagnosis

• Toxic alcohol poisoning.

c. RSI complications and modifications

d. Management priorities

• Secure the airway and control ventilation.
• Support haemodynamics.
• Give ethanol antidotal therapy: 10% ethanol 8 mL/kg IV loading dose then 1-2 mL/kg/hour, or enteral ethanol via NG/OG if used locally.
• Arrange haemodialysis.
• Admit to critical care and consider suicidality.

e. Enhanced elimination indications

• Haemodialysis is the enhanced-elimination modality of choice.
• Large ingestion with osmolar gap greater than 10.
• pH less than 7.30.
• Renal failure.
• Deteriorating vital signs.
• Methanol level greater than 16 mmol/L or ethylene glycol level greater than 8 mmol/L.