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Any alcohol (hydroxylated hydrocarbon) has the potential for toxicity. The term toxic alcohols is generally used to refer to methanol and ethylene glycol. All alcohols cause clinical inebriation, with the strength of the inebriating effects directly proportional to the alcohol’s molecular weight; hence, at the same concentration, isopropanol is more intoxicating than ethanol (Figure 179-1).

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Figure 179-1.
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Chemical structures of toxic alcohols.

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It is useful to categorize the alcohols based on whether the primary toxicity is due to the parent compound (ethanol and isopropanol) or to toxic metabolites (ethylene glycol and methanol). Ethanol and isopropanol are the most common alcohols ingested, and do not in and of themselves cause metabolic acidosis. Their principal acute toxicities are due to the GI irritant and intoxicating effects of the parent compounds, and both are significantly less toxic than methanol and ethylene glycol.

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Epidemiology

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Ethanol (CH3CH2OH, molecular weight 46.07) is a colorless, volatile liquid and is the most frequently used and abused drug in the world. Ethanol is unique among drugs of potential abuse because its use is legal and culturally acceptable in many societies. Most morbidity from acute ethanol intoxication is related to secondary injuries rather than direct toxic effects. Toxicity most commonly results from ingestion, but ethanol may also be absorbed via inhalation or percutaneous exposure.

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Ethanol is readily available in many different forms. A standard alcoholic beverage—such as 12 oz (355 mL) of beer (2% to 6% ethanol by volume), 5 oz (148 mL) of wine (10% to 20% ethanol by volume), or 1.5 oz (44 mL) of 80-proof spirits (40% ethanol by volume)—contains about 15 grams of ethanol. Ethanol may be found in high concentrations in many other common household products such as mouthwash (may contain up to 75% ethanol by volume) and colognes and perfumes (up to 40% to 60%) and as a diluent or solvent for medications (concentration varies widely between 0.4% and 65.0%). Such products are often flavored or brightly colored and may be attractive to children.

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Ethanol use contributes to the number of patients seen in the ED.1 Depending on the locale, ethanol is detected in the blood of 15% to 40% of ED patients.2

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In 2006, 32% of motor vehicle accident fatalities in the U.S. involved an alcohol-impaired driver.3 One quarter of the victims of interpersonal trauma report alcohol use by their assailants, and alcohol abuse reported by the injured woman is the strongest predictor for acute injury related to domestic violence.4,5 From data collected in 2001 and 2002, the lifetime prevalence of alcohol abuse and dependence in the U.S. was estimated to be 17.8% and 12.5%, respectively.6

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Pathophysiology

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Ethanol is rapidly absorbed after oral administration, and blood ...

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