- Always include toxic alcohols in your differential of anion gap metabolic acidosis.
- K.I.L.R for acidosis: Ketoacids, Ingestion, Lactate, Renal
- Toxic alcohols in 3 easy steps: R.B.D. = Recognize the diagnosis, Block ADH, Dialysis when needed
- Know how to calculate the osmolar gap (Measured osm - Calculated osm)
- Calculated osm = 2xNa + BUN/2.8 + Glucose/18 + ETOH/4.6
- Must be drawn at same time as BMP
- Do not wait on alcohol levels to institute alcohol dehydrogenase blocking therapy
- Ethanol and Fomepizole appear to be equally efficacious as antidotes. However, ethanol infusions have a much higher adverse event rate.
- Ketosis/ketouria, osm gap, withOUT metabolic acidosis = isopropyl alcohol
- High dose lorazepam or diazepam infusions: remember propylene glycol——lactic acid can produce acidosis.