Pyridoxine in Toxic Alcohol Poisoning

Mechanism of Action and Dosing

• Pyridoxine is administered in ethylene glycol poisoning at a dose of 50 mg IV every 6 hours to improve the conversion of glyoxylic acid into glycine, reducing the formation of toxic metabolites 1

Clinical Evidence and Rationale

• Hemodialysis is indicated in severe cases with significant acidosis or renal dysfunction, and pyridoxine is highly dialyzable, with in vivo clearance averaging 170 mL/min with cellulose filter membranes 2

Important Considerations

• During hemodialysis, supplemental doses of pyridoxine may be required due to its high dialyzability 2
• Pyridoxine supplementation is particularly important in patients with alcoholism, who may have underlying vitamin B6 deficiency 3

Monitoring and Safety

• Pyridoxine is generally safe at the doses used for toxic alcohol poisoning, but long-term high-dose pyridoxine (>300 mg/day) should be avoided due to potential neurotoxicity 3