Flashcards in Toxicology: Slide 91 Deck (203)
What is the most frequent cause of patients presenting to the ER with AMS?
What are common sources of ethanol?
Aftershave, cough preparations, glass cleaners, hair spray, disinfectants, mouthwash, paint stripper, perfumes, rubbing alcohol, beverages
What is anion gap?
Na - HCO3- Cl
What is a normal anion gap?
What toxins can cause a large anion gap?
D: DKA (alcohol ketosis, starvation ketosis, ketoacidosis, acetoacetic acid, beta hydroxybutryric acid)
P: Phenformin, metformin
I: Isoniazid, iron, inborn errors of metabolism
L: Lactic acidosis, metformin
E: Ethylene glycol
What is wood alcohol, produced via distillation of hardwood?
What are sources of methanol?
Shellac, paint thinner, rubber goods, synthetic textiles, gas line antifreeze, printing solutions, windshield washing solution, carburetor fluid
Where can you normally find methanol?
In saliva and expired air
Where is dietary methanol found?
Fruits and veggies (as free alcohol, methyl esters of fatty acids, or methoxy groups on polysaccharides such as pectin)
What is a food additive that can be converted to methanol?
-Ability to convert is really low
Does methanol distribute throughout the whole body?
What is responsible for toxicity in methanol poisoning?
Formate (it's major metabolite)
How is methanol absorbed?
All routes (rapidly from GI tract with a peak in 30-60min)
How much methanol can cause blindness?
How much methanol can cause death?
What other route of methanol ingestion is associated with toxicity?
Inhalation of vapors
What is the main route of methanol metabolism?
Via oxidation by alcohol dehydrogenase
What is another route of methanol metabolism?
Through expired air
How much of methanol is metabolized to formic acid and formaldehyde?
What is formaldehyde converted into and what is the clinical significance of this?
Formic acid- 1/2 life is 1-2 minutes and it is non-detectable
Is the metabolism of methanol faster than ethanol?
NO... it is 5 times slower than ethanol
What system regulates methanol metabolism in each species?
What species are susceptible to methanol poisoning and why?
Monkeys and humans
- Absence of large amounts of formate to be metabolized
What is the rate limiting step in methanol metabolism?
Availability of folic acid
What deficiency makes a patients more susceptible to methanol intoxication?
What 3 things do you consider in presentation of methanol poisioning?
1. Amount of food in stomach
2. Quality of ethanol consumed
3. Quantity of methanol consumed
How many more times toxic is formic acid than methanol?
What 3 things is formic acid responsible for in methanol poisioning?
1. Metabolic acidosis
2. Anion gap
3. Ocular toxicity
-CAUSES MULTISYSTEM PROBLEMS