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🍹 Toxic Alcohols - #MEDSHED
🔮 Severe hypocalcemia, acute renal failure, seizures, and cardiopulmonary arrest occur at different stages with ethylene glycol toxicity. Ethylene glycol is found in common industrial products. This toxic alcohol is metabolized by alchohol dehydragenase (ADH) into glyoaldehyde, glycolic acid, glyoxcyclic acid, and then oxalic acid.
📭 Visual disturbances and blindness are more attributed to methanol toxicity. Methanol is metabolized by ADH into formaldehyde. and then formic acid. The optic nerve is sensitive to damage from the formic acid.
🐛 Pharmacologic therapy targets prevention of ethylene glycol and methanol nto toxic compounds. Fomepizole has a high affinity for ADH and acts as a strong inhibitor. Note the change in dosing after 48 hours; fomepizole is a CYP2E1 inhibitor and inducer, producing autoinduction around 40 hours.
💉 Intravenous ethanol was used in the past obviously; this had many toxicities with targeting serum levels. Hemodialysis is the key to toxic alcohol metabolite elimination and arrangements should be initiated with any suspicion. Thiamine, pyridoxime, and magnesium may help promote elimination of some toxic metabolites.
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