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  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,
- Henry-Lagarrigue M, Charbonnier M, Bruneel F, et al. Severe alcohol hand rub overdose inducing coma, watch after H1N1 pandemic. Neurocrit Care. 2010. doi:10.1007/s12028-009-9319-4.
- Emadi A, Coberly L. Intoxication of a hospitalized patient with an isopropanol-based hand sanitizer. N Engl J Med. 2007;356:530–1. CrossRef
- Thanarajasingam G, Diedrich DA, Mueller PS. Intentional ingestion of ethanol-based hand sanitizer by a hospitalized patient with alcoholism. Mayo Clin Proc. 2007;82:1288–9. CrossRef
- Blanchet B, Charachon A, Lukat S, Huet E, Hulin A, Astier A. A case of mixed intoxication with isopropyl alcohol and propanol-1 after ingestion of a topical antiseptic solution. Clin Toxicol. 2007;45:701–4. CrossRef
- Vujasinovic M, Kocar M, Kramer K, Bunc M, Brvar M. Poisoning with 1-propanol and 2-propanol. Hum Exp Toxicol. 2007;26:975–8. CrossRef
- Wallgren H. Relative intoxicating effects on rats of ethyl, propyl and butyl alcohols. Acta Pharmacol Toxicol. 1960;16:217–22.
- Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3:208–25. CrossRef
- Pappas AA, Ackerman BH, Olsen KM, Taylor EH. Isopropanol ingestion: a report of six episodes with isopropanol and acetone serum concentration time data. J Toxicol Clin Toxicol. 1991;29:11–21. CrossRef
- MacDonald L, Kruse JA, Levy DB, Marulendra S, Sweeny PJ. Lactic acidosis and acute ethanol intoxication. Am J Emerg Med. 1994;12:32–5. CrossRef
- Lien D, Mader TJ. Survival from profound alcohol-related lactic acidosis. J Emerg Med. 1999;17:841–6. CrossRef
- Müssig K, Schleicher ED, Häring HU, Riessen R. Satisfactory outcome after severe ethanol-induced lactic acidosis and hypoglycemia. J Emerg Med. 2008;34:337–8. CrossRef
- Poisoning with Ethanol and 2-Propanol-Based Hand Rubs: Give Caesar What Belongs to Caesar!
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- Author Affiliations
- 1. Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U705, Université Paris-Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
- 2. Centre Antipoison, Hôpital Fernand Widal, Université Paris-Diderot, 75018, Paris, France