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Chapter: Modern Medical Toxicology: Neurotoxic Poisons: Inebriants

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Isopropanol - Inebriant Neurotoxic Poisons

Synonyms · Isopropyl alcohol, 2-propanol, Blue heaven.* Physical Appearance: · Colourless, volatile liquid with a faint odour of acetone and a slightly bitter taste.

Isopropanol

Synonyms

·              Isopropyl alcohol, 2-propanol, Blue heaven.*

Physical Appearance

·              Colourless, volatile liquid with a faint odour of acetone and a slightly bitter taste.

Uses

·      Rubbing alcohol (70%), for massage.

·      Disinfectant.

·      Antifreeze.

·      Paint remover.

·      Window cleaning solution.

·      Toiletries (hair tonics, after-shave lotions).

·      Industrial solvent.

Usual Fatal Dose

·              About 250 to 300 ml.

·              In terms of blood level: > 300 mg%.

Toxicokinetics

·              Isopropanol can be absorbed through all routes. In the body it is rapidly metabolised by alcohol dehydrogenase. Approximately 80% is converted to acetone and the remainder is excreted unchanged in the urine. Acetone is excreted in the urine and breath, and also metabolised to acetate, formate, and carbon dioxide.

Mode of Action

·              Isopropanol is two to three times more potent than ethanol as a CNS depressant.

Clinical Features

·              Lethargy, vertigo, headache, confusion, ataxia, dysarthria, nystagmus, miosis, abdominal pain, gastritis, haemorrhagic tracheobronchitis, hypotension, and apnoea. Isopropanol is generally believed to produce greater CNS depression than ethanol at comparable blood levels. Deep coma and

·              areflexia are common following severe intoxication. Ketonaemia and ketonuria may be present, generally without metabolic acidosis.

·              Emesis and haemorrhagic gastritis may occur following ingestion.

·              It can also cause haemolytic anaemia, myopathy, and acute renal failure.

·              A characteristic odour of acetone is usually perceptible in the breath.

Diagnosis

·              Ketonuria.

·              Determine serum isopropanol concentration and blood glucose. Blood isopropanol concentrations of 128 to 200 mg/100 ml, measured within hours after ingestion, have been associated with deep coma and death.

·              The absence of hyperglycaemia or glucosuria when acetone is present helps differentiate between alcohol intoxication or diabetic ketoacidosis versus isopropanol intoxication Isopropanol is metabolised to acetone. As acetone may contribute to CNS depression, its blood level should also be routinely obtained and followed. Acetone may be detectable in the urine by 3 hours after ingestion, and in the blood by one-half to one hour after isopropanol inges- tion. A high serum or urinary acetone without metabolic acidosis is strongly suggestive of isopropanol intoxication.

·              Increased osmolal gap.

·              High anion gap metabolic acidosis.

Treatment

·              Skin decontamination in the case of dermal exposure. Stomach wash and activated charcoal in the case of inges- tion. However, many investigators are of the opinion that activated charcoal does not adsorb isopropanol efficiently.

·              Haemodialysis: Useful in patients demonstrating marked symptoms (persistent hypotension, coma) unresponsive to standard therapy.

·              Supportive measures, including correction of hypotension, metabolic acidosis, etc.

Forensic Issues

·              Isopropanol may be generated spontaneously in a dead body, presumably due to bacterial or other putrefaction processes. This fact must be borne in mind when subjecting viscera to chemical analysis.

 

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