What is the equivalent of 330 mg/dL ethanol (etoh) in mmol/L and how is a patient with this level of ethanol intoxication managed?

Conversion of 330 mg/dL Ethanol to mmol/L and Management of Ethanol Intoxication

330 mg/dL of ethanol is equivalent to approximately 71.7 mmol/L, and a patient with this level requires immediate supportive care with consideration for hemodialysis due to severe intoxication.

Conversion Calculation

To convert ethanol from mg/dL to mmol/L:

• Molecular weight of ethanol (C₂H₅OH) = 46.07 g/mol
• 330 mg/dL ÷ 46.07 g/mol = 7.17 mmol/dL
• 7.17 mmol/dL × 10 = 71.7 mmol/L

Clinical Significance and Management

Severity Assessment

• 330 mg/dL (71.7 mmol/L) represents severe ethanol intoxication
• At concentrations >250 mg/dL, patients are at risk of coma 1
• This level exceeds thresholds for respiratory depression and potentially life-threatening complications

Initial Management

1. Airway, Breathing, Circulation

   • Secure airway if GCS <8 or unable to protect airway
   • Monitor respiratory status closely
   • Assess cardiovascular stability and provide support if needed

2. Essential Medications

   • Administer thiamine 100 mg IV before glucose administration
   • Provide glucose if hypoglycemic

3. Laboratory Assessment

   • Obtain complete metabolic panel
   • Check for concurrent toxic ingestions
   • Monitor acid-base status
   • Calculate osmolal gap = measured osmolality - calculated osmolality
     • Calculated osmolality = 2[Na⁺] + [glucose]/18 + [BUN]/2.8

Consideration for Hemodialysis

At 330 mg/dL (71.7 mmol/L), hemodialysis should be strongly considered based on:

1. Ethanol Level Criteria

   • This level significantly exceeds the threshold of 250 mg/dL associated with coma risk 1
   • The EXTRIP workgroup guidelines suggest extracorporeal treatment for toxic alcohols with high levels 2

2. Clinical Indications

   • Evidence of end-organ damage (cardiac, respiratory, neurological)
   • Failure to improve with supportive care
   • Persistent coma despite several hours of supportive management

3. Benefits of Hemodialysis

   • Can increase ethanol elimination by approximately 4-fold 3
   • May prevent further cardiotoxicity and electrolyte abnormalities
   • Significantly reduces time to clinical improvement

Monitoring and Expected Clearance

• Without intervention, ethanol clearance averages 15-20 mg/dL/hour in non-dependent adults 1, 4
• With this clearance rate, a level of 330 mg/dL would take approximately 16-22 hours to reach non-toxic levels
• Hemodialysis can reduce this time significantly to 4-6 hours 3

Cessation of Treatment

• Continue supportive care until ethanol level <100 mg/dL
• If hemodialysis was initiated, consider stopping when:
  • Ethanol level <100 mg/dL
  • Clinical improvement with return of normal mental status
  • Resolution of any metabolic derangements

Potential Complications

• Respiratory depression requiring mechanical ventilation
• Hypotension potentially requiring vasopressors
• Hypothermia
• Hypoglycemia
• Aspiration pneumonia
• Rhabdomyolysis in prolonged immobility cases

This severe level of ethanol intoxication (330 mg/dL or 71.7 mmol/L) requires immediate and aggressive management with close monitoring in an intensive care setting, with strong consideration for hemodialysis to expedite ethanol clearance and prevent further end-organ damage.