If there is suspicion of isopropanol poisoning, intravenous access should be established with bedside testing for blood glucose, and administration of thiamine and naloxone if indicated. Patients should be monitored for central nervous system or respiratory depression. Because of the rapid absorption of isopropanol, there is no utility to performing gastric lavage. Activated charcoal binds isopropanol poorly and is not necessary in the absence of ingestion of adsorbable substances. Laboratory studies are guided by the results of examination and clinical condition. Serum electrolytes, CBC, glucose, and acetone are generally needed as a minimum.
In severely obtunded patients, airway management may require intubation and ventilatory support. Hypotension usually responds to intravenous fluids. In severe cases, support with pressors may be indicated. Patients with severe hemorrhagic gastritis may require blood transfusion. The acidosis associated with isopropanol poisoning is usually mild. If acidosis is significant, vigorous investigation for another cause must be made. For example, if the patient is hypotensive, consider lactic acidosis. Hemodialysis is indicated when hypotension is refractory to conventional therapy, resulting in hemodynamic instability, or when the predicted peak isopropanol level is greater than 400 mg/dL. Hemodialysis is effective in eliminating both isopropanol and acetone. Peritoneal dialysis is less effective.
Patients with lethargy or prolonged central nervous system depression should be admitted to the hospital. Those who remain asymptomatic for 6 to 8 h may be discharged or referred for substance abuse counseling or psychiatric evaluation.
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