Toxic Alcohol, General

Toxic Alcohol, General is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • High alcohol concentrations increase the measured plasma osmolality and subsequently widen the osmolar gap. A normal gap is <10 mmol/dL and varies from −14 to +10 mmol/dL.1
  • In presence of a widened gap, the actual serum alcohol level can be estimated if done early after ingestion2 with the following calculation:
  • As the alcohol is metabolized, the osmolar gap falls, and the anion gap rises.3 Therefore, the osmolar gap should only be used to support the diagnosis of toxic alcohol poisoning and not to draw conclusions about the actual amount of ingested toxin.
  • The specific molecular weights for each alcohol can be found in the following sections.
  • Unlike methanol and ethylene glycol, isopropanol (rubbing alcohol) does not form a toxic metabolite.

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General Principles

  • High alcohol concentrations increase the measured plasma osmolality and subsequently widen the osmolar gap. A normal gap is <10 mmol/dL and varies from −14 to +10 mmol/dL.1
  • In presence of a widened gap, the actual serum alcohol level can be estimated if done early after ingestion2 with the following calculation:
  • As the alcohol is metabolized, the osmolar gap falls, and the anion gap rises.3 Therefore, the osmolar gap should only be used to support the diagnosis of toxic alcohol poisoning and not to draw conclusions about the actual amount of ingested toxin.
  • The specific molecular weights for each alcohol can be found in the following sections.
  • Unlike methanol and ethylene glycol, isopropanol (rubbing alcohol) does not form a toxic metabolite.

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