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  • rubbing alcohol
  • skin lotions
  • hair tonics
  • aftershave
  • de-icers
  • glass cleaners

Mechanism of toxicity

  • metabolized by alcohol dehydrogenase to acetone

Clinical features

  • ketones on breath
  • ketonuria
  • absence of elevated anion gap or metabolic acidosis
  • high osmolal gap
  • haemorrhagic gastritis
  • renal tubular necrosis
  • myopathy
  • haemolytic anaemia
  • hypotension ± death in severe cases


  • Gastric lavage may be helpful if performed in first hour after ingestion
  • In most patients only supportive therapy indicated
  • Haemodialysis for:
    • ingestion of a lethal dose (150-240 ml 40-70% solution)
    • lethal serum levels (400 mg/dl)
    • refractory shock
    • prolonged coma

Further reading

Mokhlesi B et al. Adult toxicology in critical care. Part II: Specific poisonings. Chest, 2003; 123:897-922

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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