Neurocritical Care

, Volume 30, Issue 1, pp 226–228 | Cite as

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

  • Bruno MégarbaneEmail author
  • Antoine Villa
Letter to the Editor

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...



The authors would like to acknowledge Jenny Lu, MD, from Toxikon Consortium, Chicago, USA for her review of this manuscript.

Conflict of Interest Statement



  1. 1.
    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.
  2. 2.
    Emadi A, Coberly L. Intoxication of a hospitalized patient with an isopropanol-based hand sanitizer. N Engl J Med. 2007;356:530–1.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    Vujasinovic M, Kocar M, Kramer K, Bunc M, Brvar M. Poisoning with 1-propanol and 2-propanol. Hum Exp Toxicol. 2007;26:975–8.CrossRefGoogle Scholar
  6. 6.
    Wallgren H. Relative intoxicating effects on rats of ethyl, propyl and butyl alcohols. Acta Pharmacol Toxicol. 1960;16:217–22.CrossRefGoogle Scholar
  7. 7.
    Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3:208–25.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    MacDonald L, Kruse JA, Levy DB, Marulendra S, Sweeny PJ. Lactic acidosis and acute ethanol intoxication. Am J Emerg Med. 1994;12:32–5.CrossRefGoogle Scholar
  10. 10.
    Lien D, Mader TJ. Survival from profound alcohol-related lactic acidosis. J Emerg Med. 1999;17:841–6.CrossRefGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U705Université Paris-DiderotParisFrance
  2. 2.Centre Antipoison, Hôpital Fernand WidalUniversité Paris-DiderotParisFrance

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