What is the treatment for rubbing (isopropyl alcohol) poisoning?

Treatment of Isopropyl Alcohol (Rubbing Alcohol) Poisoning

Supportive care with emphasis on respiratory and cardiovascular support is the primary treatment for isopropyl alcohol poisoning, with hemodialysis reserved for severe life-threatening cases. 1

Immediate Stabilization

The initial management focuses on stabilizing vital functions and preventing further deterioration:

• Airway and breathing support is the first priority, as severe poisoning causes CNS and respiratory depression that can progress to respiratory failure 1
• Cardiovascular support must be initiated promptly, as shock and circulatory collapse are major features of severe poisoning 1
• Intravenous fluid resuscitation should be administered to maintain hemodynamic stability and support renal perfusion 1
• Continuous monitoring of vital signs, mental status, and respiratory function is essential given the risk of rapid deterioration 1

Diagnostic Considerations

While providing supportive care, certain diagnostic features help confirm the diagnosis:

• Osmol gap elevation without metabolic acidosis is characteristic and helps distinguish isopropanol from other toxic alcohol ingestions 1
• Ketonemia and ketonuria occur due to acetone production (the primary metabolite of isopropanol) without accompanying acidosis 1
• Fruity or sweet breath odor from acetone may be present and supports the clinical diagnosis 1
• Serum isopropanol concentrations can confirm diagnosis but are typically not readily available and should not delay treatment 1

Supportive Care Protocol

The cornerstone of management is symptom-directed supportive therapy:

• Respiratory support ranges from supplemental oxygen to mechanical ventilation depending on the degree of CNS depression 1
• Hemodynamic support with IV fluids and vasopressors if needed to maintain adequate perfusion 1
• Monitoring for complications including aspiration pneumonia, rhabdomyolysis, and acute kidney injury 1
• Observation period should continue until clinical improvement is evident and acetone levels are declining, as acetone has a longer elimination half-life (7.7-27 hours) than isopropanol (2.5-8 hours) 1

Hemodialysis Indications

Hemodialysis substantially enhances elimination of both isopropanol and acetone but should only be considered in severe life-threatening poisonings 1:

• Profound CNS depression unresponsive to supportive measures 1
• Refractory hypotension or shock 1
• Significantly elevated serum isopropanol levels with severe clinical toxicity 1
• Acute kidney injury complicating the clinical course 1

What NOT to Do

Several common pitfalls should be avoided:

• Do not use fomepizole or ethanol - these alcohol dehydrogenase inhibitors are used for methanol and ethylene glycol poisoning but are not indicated for isopropanol, as the metabolite acetone is less toxic than the parent compound 2, 3, 1
• Do not assume metabolic acidosis will be present - unlike methanol and ethylene glycol poisoning, isopropanol typically causes ketonemia without significant acidosis 1
• Do not routinely perform hemodialysis - reserve this intervention only for severe life-threatening cases, as most patients recover with supportive care alone 1

Expected Clinical Course

With appropriate supportive management:

• Most patients make a full recovery provided they receive prompt supportive care 1
• Peak plasma concentrations occur within 30 minutes of ingestion 1
• Clinical improvement typically follows the elimination kinetics, with isopropanol cleared faster than its metabolite acetone 1
• Deaths are rare despite isopropanol poisoning being reasonably common 1