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|Drug Toxicity with Specific Antidotes
📖 About
- Ethanol toxicity results from acute alcohol overdose, leading to central nervous system (CNS) depression, impaired airway reflexes, and risk of multi-organ complications.
- Ethanol is metabolised by alcohol dehydrogenase (ADH) to acetaldehyde, then by acetaldehyde dehydrogenase (ALDH) to acetate in the liver. Unlike methanol or ethylene glycol, ethanol itself is relatively less toxic but causes death through coma and respiratory depression.
- Ethanol is not only in drinks but also in household products (mouthwash, hand sanitiser, antiseptics) – accidental ingestion is common in children.
⚖️ Levels of Toxicity
- Mild: <150 mg/dL – minor impairment, mild euphoria.
- Moderate: 150–300 mg/dL – ataxia, dysarthria, disinhibition.
- Severe: 300–500 mg/dL – coma, aspiration, respiratory depression.
- Critical: >500 mg/dL – high fatality risk if untreated.
🧪 Aetiology & Clinical Features
- Rapid GI absorption → peak blood levels in ~1 hr.
- Low dose: incoordination, delayed reaction times, euphoria.
- Moderate dose: dysarthria, diplopia, sweating, aggression.
- High dose: profound CNS depression, hypothermia, coma, respiratory failure.
- Safeguarding alert 🚨: in children/adolescents, always consider non-accidental injury, neglect, or unsafe supervision.
🔍 Investigations
- ABG: may show metabolic acidosis (usually lactic).
- FBC: macrocytosis, anaemia, infection screen.
- LFTs: hepatocellular damage, GGT elevation.
- U&E: check renal impairment, electrolyte imbalance (esp. hypokalaemia, hypomagnesaemia).
- Blood glucose: hypoglycaemia is common.
- 💡 Osmolar gap = measured osmolality – calculated osmolality; raised in toxic alcohol ingestion, helps rule out methanol/ethylene glycol co-ingestion.
💊 Management
- Initial: ABCs – airway protection is critical; intubation if GCS falls <8 or loss of protective reflexes. Place in recovery position if unconscious but breathing.
- Monitoring: neuro obs, TPR, O₂ sats, ECG, hourly GCS.
- Supportive care: IV normal saline for dehydration; correct hypoglycaemia with IV dextrose after IV thiamine (Pabrinex) in chronic alcoholics to prevent Wernicke’s.
- Seizures: treat with benzodiazepines (diazepam).
- Dialysis: consider if blood ethanol >400 mg/dL (4 g/L), refractory metabolic acidosis (pH <7.1), or multi-organ failure.
- Most cases resolve in 8–12h with careful monitoring. Discharge only when patient is alert, mobilising safely, and has safeguarding/aftercare plan.
