Toxic Alcohol Ingestion: Prompt Recognition and Management in the Emergency Department (Critical Care Topic and Pharmacology CME) - $49.00
Publication Date: September 2016 (Volume 18, Number 9)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 9/1/2019
Specialty CME Credits:: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional approval.
Gillian A. Beauchamp, MD
Adjunct Instructor, Oregon Health & Science University, Department of Emergency Medicine; Toxicology Fellow, Oregon and Alaska Poison Centers, Portland, OR
Matthew Valento, MD
Acting Assistant Professor, Division of Emergency Medicine, University of Washington; Interim Medical Director, Washington Poison Center, Seattle, WA
Theodore C. Bania, MD, MS
Director of Research and Toxicology, Department of Emergency Medicine, Mount Sinai Roosevelt-Mount Sinai St. Luke’s Hospital; Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Ruben E. Olmedo, MD
Director, Division of Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites. This issue reviews common sources of alcohol exposure, basic mechanisms of toxicity, physical examination and laboratory findings that may guide rapid assessment and management, and indications for treatment.
Excerpt From This Issue
A 27-year-old man with a history of depression presents after a reported ingestion of “about 8 ounces” of a workplace industrial solvent that has been identified by a shift supervisor as diethylene glycol. You are familiar with ethylene glycol and wonder if diethylene glycol poisoning results in similar toxicity. The patient has normal vital signs and a normal examination. What laboratory testing is warranted in this patient? Is it possible to obtain a diethylene glycol level? Based on this reported ingestion, what treatment is warranted?
Francisco Gonzalez-Rosales, MD - 08/10/2017 Very good presentation and practical.
Kimber Ward, MD - 07/06/2017 After this course, I will have better evaluation and management of toxic alcohol ingestion.
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