From the Research
Isopropyl alcohol does not cause an anion gap (AG) acidosis, instead, it typically causes a normal anion gap metabolic acidosis. When isopropyl alcohol is metabolized in the body, it is converted to acetone by alcohol dehydrogenase, but unlike ethanol or methanol, it does not produce acidic metabolites like formic acid or lactic acid that would contribute to an anion gap 1. Acetone is a ketone that can be detected in the blood and urine but does not significantly affect the anion gap.
Key Points
- Isopropyl alcohol ingestion typically causes a normal anion gap metabolic acidosis, not an anion gap acidosis
- The metabolism of isopropyl alcohol to acetone does not produce acidic metabolites that contribute to an anion gap
- Patients with isopropyl alcohol poisoning often present with symptoms including CNS depression, gastritis, hypotension, and a fruity odor on their breath due to acetone
- Treatment involves supportive care, as there is no specific antidote
Comparison with Other Alcohols
- Methanol and ethylene glycol poisoning cause anion gap metabolic acidosis due to their toxic acidic metabolites 2, 3, 1
- Isopropyl alcohol poisoning is distinct from these and requires different management
- Understanding this distinction is important for proper diagnosis and management of alcohol poisonings
Clinical Implications
- A high index of suspicion for isopropyl alcohol poisoning is necessary to initiate early treatment and prevent significant morbidity and mortality
- Laboratory abnormalities, such as normal anion gap metabolic acidosis, can be helpful for diagnosis, but may be absent depending on the time of ingestion and presentation 4, 5