Isopropanol or isopropyl alcohol is a transparent, colorless liquid that is a major component of rubbing alcohol as well as regular household items such as cleaners, disinfectants, and hand sanitizers; Pharmaceutical industries also use high quality isopropyl alcohol in bulk as a disinfectant. Similar to other toxic alcohol ingestion, clinical symptoms of isopropanol ingestion range from clinical intoxication to profound obtundation.
Diagnosis of isopropanol ingestion relies on astute history and physical examination, laboratory values that are significant for an elevated urine acetone level, and a wide serum osmolar gap. Interestingly, unlike the other toxic alcohols and their metabolites, which produce large anion gap metabolic acidosis, isopropanol is metabolized by alcohol dehydrogenase to its metabolite, acetone, which does not cause an anion gap metabolic acidosis and cannot be metabolized to a compound that does.
As such, treatment with fomepizole, an alcohol dehydrogenase competitive inhibitor actually prolongs the effect of isopropanol, because isopropanol cannot be metabolized to its byproduct for elimination. Treatment of isopropanol poisoning is largely supportive. Hemodialysis can be initiated to enhance the elimination of the parent drug but is rarely indicated because patients rapidly improve with supportive care alone.
Furthermore, there is no definitive clinical evidence that hemodialysis improves patient outcomes in severe isopropanol poisoning. The risks and benefits of hemodialysis may be considered for comatose patients with blood isopropanol levels exceeding 500 mg.