Toxic Alcohols

Anion Gap Metabolic Acidosis

Definition: [Measured cations - measured anions] = [Na+] - [Cl- + HCO3-] = 140 - [110 + 24] = 6.

Normal range: 3-11.

High: MMUDPPIILEESS = Methanol, Met-formin, Uremia, Diabetic ketoacidosis, Par-aldehyde, Phenformin, INH, Iron, Lactic acidosis, Ethanol, Ethylene glycol, Salicy-lates, and Solvents. MMETAL ACCIID GAPP = Methanol, Metformin, Ethylene glycol, Toluene, Alcohol ketoacidosis, Lactic acidosis, Aspirin, Carbon monoxide, Cyanide, Isoniazid, Iron, Diabetic ketoacidosis, Generalized seizures, Aminoglycosides, Par-aldehyde, Phenoformin. Low: Bromides (falsely elevated anionic chloride levels).

without food increase absorption; hepatically oxidized by three pathways:

Pathway 1: Alcohol dehydrogenase (ADH) [EtOH ^ (ADH) ^ Acetaldehyde (acetalde-hyde dehydrogenase) ^ Acetyl CoA ^ (thiamine cofactor) ^ Kreb's tricarboxylic acid (TCA) cycle ^ CO2 + H2O]. Pathway 2: CYP-450 (inducible metabolism).

Pathway 3 : hepatic peroxidase-catalase. Toxicity: CNS > gastrointestinal > metabolic. CNS: Inebriation, disinhibition, incoordination, blurred vision, diplopia, confusion, CNS and respiratory depression. Gastrointestinal: Nausea, vomiting, cramping abdominal pain, gastric bleeding. Metabolic: High anion gap metabolic aci-dosis, high osmolal gap metabolic acidosis, hypoglycemia, hypokalemia, hypomagnese-mia, hypophosphatemia, hyperamylasemia.

Osmol Gap Metabolic Acidosis

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