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.
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.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.