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<< Toxic Alcohol Ingestion: Prompt Recognition and Management in the Emergency Department (Critical Care Topic and Pharmacology CME)

Emergency Department Evaluation

History

In patients with possible toxic alcohol exposure, it is valuable to elicit any history of co-ingestions, including ethanol, as well as details of any ethanol or toxic alcohol exposure, including time of ingestion, type of ingestion, and amount ingested. The presence of significant ethanol intoxication is protective when it is ingested with methanol or ethylene glycol, as ethanol will prevent the development of toxic metabolites. However, the presence of ethanol in the setting of an anion gap acidosis does not eliminate the possibility of the acidosis being caused by a toxic alcohol, if the ethanol was ingested several hours after the metabolism of the toxic alcohol. Conversely, treatment with antidotal ethanol or fomepizole in patients with markedly elevated ethanol concentrations may prolong intoxication, so obtaining a history of the approximate amount of any type of alcohol consumption is helpful. It is important to assess the intoxicated patient for comorbidities, and any history of alcohol withdrawal.

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