Toxic Alcohol Ingestion: Clinical Features, Diagnosis, and Management

Methanol intoxication:

 • Accidental or intentional ingestion of adulterated alcohol or products with methanol; rare cases of inhalation of methanol

 • Dx: Osmolal gap with HAGAc, Visual difficulties with optic papillitis

Ethylene glycol intoxication:

 • Accidental or intentional ingestion of antifreeze, alcohol adulterated with ethylene glycol, or products with ethylene glycol

 • Dx: Osmolal gap with HAGAc, ARF with osmolal gap, Calcium oxalate crystals in urine, monohydrate or dihydrate

Diethylene glycol intoxication:

 • Ingestion of contaminated medication or products with diethylene glycol

 • Dx: Osmolal gap with HAGAc, Osmolal gap with ARF, Osmolal gap with coma

Propylene glycol intoxication:

 • Intravenous administration of medication with propylene glycol; rare ingestion of products with propylene glycol

 • Dx: Osmolal gap with or without LA

Isopropanol intoxication:

 • Accidental or intentional ingestion of rubbing alcohol

 • Dx: Osmolal gap without HAGA

Alcoholic ketoacidosis:

 • Binge drinking often in alcoholic patients associated with starvation and often vomiting 

 • Dx: HAGA, trace positive or negative nitroprusside reaction with increase with H2O2; hypoglycemia; osmolal gap



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