Fomepizole:
Indications:<unk><unk>  level >20mg/dL
Suspected significant<unk><unk>  ingestion with ETOH level <100mg/dL
Coma or altered mental status in patient with unclear history and osm gap >10
Coma or altered mental status in patient with unclear history and unexplained met acidosis and ETOH level <100
Dosing
15mg/kg IV over 30min; follow by 10mg/kg q12hr until level <20 or acidosis resolves<unk><unk>  level >20mg/dL
Suspected significant<unk><unk>  ingestion with ETOH level <100mg/dL
Coma or altered mental status in patient with unclear history and osm gap >10
Coma or altered mental status in patient with unclear history and unexplained met acidosis and ETOH level <100
15mg/kg IV over 30min; follow by 10mg/kg q12hr until level <20 or acidosis resolves
Ethanol:
Ethanol drips are rarely used
BAL of 100-150 completely saturates alcohol dehydrogenase
Dosing:
IV: load 800mg/kg; then give 100mg/kg/hr
Oral: 3-4 1-oz "shots" of 80-proof liquor); then give 1-2 "shots" per hour
IV: load 800mg/kg; then give 100mg/kg/hr
Oral: 3-4 1-oz "shots" of 80-proof liquor); then give 1-2 "shots" per hour
Acidemia leads to protonation of oxalate which increases penetration to end organ tissues and causes more damage
Bicarbonate infusion is an option however the patient will need to compensate with an increased respiratory rate (or mechanical ventilation which is frequently unsafe in severely acidotic patients) - otherwise a concomitant respiratory acidosis will ensue
Bicarbonate 1-2mEq/kg IV bolus to attain pH = 7.45-7.50
Follow by infusion of 150mEq/L in D5 @ 1.5-2 times maintenance fluid rate
Monitor for worsening hypocalcemia
Must correct hypocalcemia, but be cautious of increased calcium oxalate crystal production
Follow by infusion of 150mEq/L in D5 @ 1.5-2 times maintenance fluid rate
Must correct hypocalcemia, but be cautious of increased calcium oxalate crystal production
Indications:
Refractory metabolic acidosis (pH <7.25) with AG >30 and base deficit < -15
Renal insufficiency (serum Cr >3.0 mg/dL or increase in Cr by 1.0 mg/dL)
Deteriorating vital signs despite aggressive supportive care
Electrolyte abnormalities refractory to conventional therapy<unk><unk>  level >50mg/dL (controversial)<unk> ic acid level > 8 mmol/L<unk> ic acid is metabolite that causes anion gap acidosis)
Refractory metabolic acidosis (pH <7.25) with AG >30 and base deficit < -15
Renal insufficiency (serum Cr >3.0 mg/dL or increase in Cr by 1.0 mg/dL)
Deteriorating vital signs despite aggressive supportive care
Electrolyte abnormalities refractory to conventional therapy<unk><unk>  level >50mg/dL (controversial)<unk> ic acid level > 8 mmol/L<unk> ic acid is metabolite that causes anion gap acidosis)
Thiamine 100mg IV q6hr x2d
May promote glyoxalate conversion to alpha-hydroxy-beta-ketoadipate
Pyridoxine 50mg q6hr x2d
May inhibit metabolism of glyoxalate to oxalate
Magnesium 2gm IV x1
May promote glyoxalate conversion to alpha-hydroxy-beta-ketoadipate
May inhibit metabolism of glyoxalate to oxalate
Ethylene glycol toxicity
Absinthe
Methane toxicity
Barbiturates
Hydrazine toxicity
Benzodiazepines
Methanol toxicity
Flunitrazepam 