Clinical Features

The clinical features of isopropanol intoxication are similar to those seen with ethanol intoxication except that the duration of symptoms and signs is longer and central nervous system depression may be more profound because of the formation of acetone. Onset of symptoms occurs within 30 to 60 min, with peak effects in a few hours. Nystagmus is usually present. Severe poisoning is marked by early onset of coma, respiratory depression, and hypotension. 7

Massive ingestion may cause hypotension secondary to peripheral vasodilatation, with contributions possible from hemorrhagic gastritis. Serious dysrhythmias are rare.7

Hemorrhagic gastritis secondary to gastric irritation appears early and is a striking feature of isopropanol ingestions, resulting in nausea, vomiting, abdominal pain, and upper gastrointestinal hemorrhage.7

Hypoglycemia may occur secondary to depressed gluconeogenesis. Less common complications include hepatic dysfunction, acute tubular necrosis, myoglobinuria, hemolytic anemia, rhabdomyolysis, and myopathy.7

Isopropanol poisoning should be suspected when the smell of rubbing alcohol is present on the breath, when there is acidosis associated with ketonuria and ketonemia without glycosuria or hyperglycemia, and in the presence of an elevated osmolal gap.7 Acidosis, if present, is mild. The use of alcohol screening panels helps detect unsuspected isopropanolism.

As previously mentioned, isopropanol has approximately twice the intoxicating effect of ethanol at the same blood concentration. Although isopropanol levels of 50 mg/dL are associated with mild intoxication in individuals who are not habituated to ethanol, alcoholic patients may be considerably more resistant to the central nervous system effects of isopropanol.

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