Management of Ethanol Toxicity

Differential Diagnosis Considerations

• The American Thoracic Society recommends ruling out toxic co-ingestions systematically, particularly methanol or ethylene glycol if there is unexplained metabolic acidosis with elevated anion gap, as 44% of intentional poisonings involve multiple drugs or ethanol combinations 1
• The American College of Medical Toxicology suggests screening for other substances in intentional poisonings, as multiple drug or ethanol combinations are common 1
• Measurement of anion gap (Na+ + K+ - Cl- - HCO3-) is recommended to detect toxic alcohol co-ingestion, with values >27 mmol/L suggesting severe methanol or ethylene glycol poisoning requiring different management 3