Diagnosis of toxic alcohols: limitations of present methods

Clin Toxicol (Phila). 2015;53(7):589-95. doi: 10.3109/15563650.2015.1056880. Epub 2015 Jun 26.

Abstract

Context: Methanol, ethylene glycol, diethylene glycol, and propylene glycol intoxications are associated with cellular dysfunction and an increased risk of death. Adverse effects can develop quickly; thus, there is a need for methods for rapidly detecting their presence.

Objective: To examine the value and limitations of present methods to diagnose patients with possible toxic alcohol exposure.

Methods: I searched MEDLINE for articles published between 1969 and 2014 using the terms: toxic alcohols, serum osmolality, serum osmol gap, serum anion gap, metabolic acidosis, methanol, ethylene glycol, diethylene glycol, propylene glycol, and fomepizole. Each article was reviewed for additional references.

Results: The diagnosis of toxic alcohol exposure is often made on the basis of this history and physical findings along with an increase in the serum osmol and anion gaps. However, an increase in the osmol and/or anion gaps is not always present. Definitive detection in blood requires gas or liquid chromatography, laborious and expensive procedures which are not always available. Newer methods including a qualitative colorimetric test for detection of all alcohols or enzymatic tests for a specific alcohol might allow for more rapid diagnosis.

Conclusions: Exposure to toxic alcohols is associated with cellular dysfunction and increased risk of death. Treatment, if initiated early, can markedly improve outcome, but present methods of diagnosis including changes in serum osmol and anion gap, and use of gas or liquid chromatography have important limitations. Development of more rapid and effective tests for detection of these intoxications is essential for optimal care of patients.

Keywords: Ethylene glycol; Fomepizole; Methanol; Propylene glycol; Serum anion gap; Serum osmolal gap; Toxic alcohols.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Acid-Base Equilibrium
  • Acidosis / blood
  • Alcohols / poisoning*
  • Ethylene Glycol / blood*
  • Ethylene Glycols / blood*
  • Fomepizole
  • Humans
  • Methanol / blood*
  • Osmolar Concentration
  • Propylene Glycol / blood*
  • Pyrazoles / blood

Substances

  • Alcohols
  • Ethylene Glycols
  • Pyrazoles
  • diethylene glycol
  • Propylene Glycol
  • Fomepizole
  • Ethylene Glycol
  • Methanol