What is Isopropanol Toxicity?
Isopropanol, also known as isopropyl alcohol, is a transparent, colorless liquid with a smell similar to that of acetone (a common ingredient in nail polish remover). It’s commercially available and is mostly found as a 70% solution in products like rubbing alcohol and hand sanitizers. Unlike some other harmful alcohols, isopropanol usually doesn’t cause death and is linked to a condition called ketosis which, unusually, doesn’t involve acid build-up in the body. If someone accidentally swallows isopropanol, the treatment generally involves supportive care, meaning medical professionals monitor and help maintain the patient’s vital functions. This kind of accidental consumption is rarely fatal.
What Causes Isopropanol Toxicity?
This is usually caused by unintentionally taking too much of a substance called isopropyl alcohol.
Risk Factors and Frequency for Isopropanol Toxicity
Isopropanol, also known as rubbing alcohol, is the second most commonly ingested alcohol after ethanol, or drinking alcohol. However, it is the most common toxic alcohol that people accidentally or intentionally consume in the United States, according to annual reports from poison control centers.
- In 2009 alone, the American Association of Poison Control Centers had more than 20,000 cases related to isopropanol.
- Over 80% of these cases were incidents where it was consumed by mistake.
- Beyond accidental ingestions, isopropanol is often misused as a cheap and easily accessible alternative to drinking alcohol.
- There have been incidents where large quantities of rubbing alcohol were accidentally absorbed through the skin, or where kids accidentally drank it.
Signs and Symptoms of Isopropanol Toxicity
Isopropyl alcohol toxicity, or poisoning, tends to follow a pattern where a person rapidly becomes drunk, followed by a condition known as hemorrhagic gastritis, which is severe inflammation of the stomach lining often accompanied by bleeding. It can be difficult to tell just from a person’s medical history and physical examination what type of toxic alcohol they have ingested. However, should the person have ingested isopropanol, they may feel dizzy, suffer from headaches, and feel heavily intoxicated. This is due to acetone, which is a strong substance that slows down the brain’s functions. As isopropanol irritates the digestive system, patients may also experience symptoms such as stomach pain, feeling sick, vomiting, and vomiting blood.
When examining a person physically, it may appear that they are intoxicated from drinking ethanol (commonly found in alcoholic beverages). This is because isopropanol has similar, but more severe effects due to its chemical structure allowing it to impact the brain more effectively. It could lead to altered consciousness, low blood pressure, dangerously low body temperature, and even potentially lethal conditions affecting heart and lung function. Extremely low blood pressure is linked to severe overdosing and nearly 45% of such cases could result in death. Additionally, they may have unusually small pupils, a common sign noticed during eye exams. Patients may also lose reflexes including those that are deep tendon (jerk reflexes) and corneal (blink reflex), and may react unusually to testing of the plantar reflex (reflex movement of the foot).
Testing for Isopropanol Toxicity
If your doctor thinks you may have consumed a poisonous type of alcohol, and they’re not sure which kind, they’ll likely order several different blood tests for you. These tests might check your red and white blood cell counts, your liver function, whether you’re pregnant, the level of acids called ketones in your blood or urine, as well as your blood levels of ethanol (the type of alcohol found in alcoholic beverages), acetaminophen (a common pain reliever), and salicylate (a substance found in many pain relievers). They’ll also probably want to take an electrocardiogram, which is a test that looks at the electrical activity of your heart.
Unfortunately, directly testing for poisonous alcohols can be difficult because most hospitals don’t have the specific equipment needed. That’s why they rely on these other tests as clues to what you might have consumed.
One type of poisonous alcohol, called isopropanol, has a unique effect on your body. If you’ve consumed isopropanol, your body will make more ketones (which we mentioned earlier), but unlike with most other poisonous alcohols, it won’t make more acids. Your blood sugar level will also likely be normal. The active substance in isopropanol that causes these effects is called acetone. Despite these differences, your doctor may still notice an early sign of isopropanol consumption, which is an increase in the concentration of certain particles in your blood (known as the osmolar gap).
Furthermore, consumption of isopropanol might create a situation that appears like kidney failure on lab tests. This occurs due to a reaction called the Jaffe reaction, which is a testing method used to measure the creatinine levels (a waste product that’s typically filtered by the kidneys) in both serum and urine. However, this rise in creatinine levels, due to the presence of acetone, can make it seem like your kidney function is impaired, even though it might not be. In fact, for every 100 mg/dL of acetone in your blood, your creatinine level might go up by 1 mg/dL. Your doctor can use this information to estimate how much acetone is in your blood.
Treatment Options for Isopropanol Toxicity
If someone accidentally ingests isopropanol, which is a type of alcohol often found in things like rubbing alcohol and some cleaning products, the main treatment is supportive care. This usually involves providing fluids directly into a vein (intravenous hydration) to help the body flush out the toxin.
Medical treatments commonly used for other types of poisoning – such as emptying the stomach or giving activated charcoal to absorb the poison – are not generally recommended in the case of isopropanol. This is because isopropanol gets absorbed into the body very quickly.
Also, unlike some other harmful alcohols, isopropanol does not turn into harmful substances inside the body. Therefore, drugs that prevent this conversion aren’t recommended. In fact, one such drug, called fomepizole, could even prolong the intoxication.
If there’s a chance the patient might be malnourished because of continually drinking too much alcohol, the doctor might recommend some specific vitamins and nutrients, like thiamine, folate, and a multivitamin.
In more severe cases of isopropanol poisoning, a treatment called hemodialysis might be considered. This involves removing the blood from the body to clean it before returning it again. However, this is generally only necessary in severe situations. For instance, if a patient has continuously low blood pressure, excessive amount of lactic acid in their blood, or a very high level of isopropanol in their blood. Even in these instances, the need for dialysis would be very rare. People who don’t become severely ill or unconscious within six hours of ingesting this type of alcohol typically won’t need this kind of treatment.
Overall, the best approach is to carefully watch the patient until they’re completely sober again.
What else can Isopropanol Toxicity be?
After having consumed isopropanol (rubbing alcohol), a person may appear disoriented or confused. There are a lot of different things that could cause this sort of behavior, but doctors use a handy tool to help them remember the most common causes. This tool is a memory-aid called “AEIOU-TIPS”, and each letter stands for a different cause:
- A – Alcohol or acid-imbalance in the body
- E – Electrolyte imbalance or encephalopathy (brain disease)
- I – Infection
- O – Overdose or problems with oxygen
- U – Uremia (kidney disease)
- T – Trauma or other toxins
- I – Insulin (which can cause problems if levels are too high or too low)
- P – Psychogenic (mental or emotional factors)
- S – Stroke or shock
The doctor will also want to check if there’s an underlying cause of ketosis (a state where the body burns fat for fuel). This is because isopropanol can cause ketosis without causing an imbalance of acidity in the body. Some other potential causes of ketosis that the doctor might want to rule out include diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis, and alcohol poisoning.
