Date: 06 Apr 2010

Poisoning with Ethanol and 2-Propanol-Based Hand Rubs: Give Caesar What Belongs to Caesar!

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To the Editor,

We read with great interest the practical pearl report by Henry-Lagarrigue and colleagues [1] and would like to comment on their interpretation of their poisoned patient’s features. The authors reported a massive ingestion of alcohol hand rub (composition: 43% ethanol and 16% 2-propanol) in a 33-year-old depressed woman resulting in a profound coma with a transient mild lactate elevation (initial blood concentration: 3.4 mmol/l and peak blood concentration: 4.8 mmol/l). Outcome was favorable following airway support with mechanical ventilation for 6 h. The authors attributed the deep coma to ethanol and the observed transient hyperlactatemia to the liver alcohol dehydrogenase (ADH)-mediated metabolism of 2-propanol, reported to be a two-step pathway: transformation of 2-propanol to propylene glycol and oxidation of propylene glycol to lactic and pyruvic acids.

At least four other cases of 2-propanol-based hand rub ingestions causing significant toxicity have been reported,