sodium-bicarbonate and Alcoholic-Intoxication

More than 6 per cent of poisonings involve alcohols and glycols, reflecting their availability in a wide range of household products, including aftershave, brake fluid, gas line antifreeze, model airplane fuel, mouthwash, rubbing alcohol, and windshield washing solution. Diagnosis involves recognition of an osmolal gap and variable degrees and delays in development of an anion gap metabolic acidosis. Therapeutic modalities are similar for methanol and ethylene glycol, both cases requiring ethanol-blocking of alcohol dehydrogenase and hemodialysis. More often, treatment of ethanol and isopropanol poisoning is limited to supportive care.

Topics: 1-Propanol; Absorption; Acidosis; Adult; Alcoholic Intoxication; Bicarbonates; Blindness; Child; Child, Preschool; Diagnosis, Differential; Ethylene Glycol; Ethylene Glycols; Gastric Lavage; Humans; Hypotension; Infant; Ipecac; Kidney Diseases; Kinetics; Liver; Methanol; Mortality; Osmolar Concentration; Renal Dialysis; Sodium; Sodium Bicarbonate

An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co-morbidities. A 59-year-old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750 mL of laminate floor cleaner containing citric acid. The patient was admitted with severe metabolic acidosis (both ketoacidosis and lactic acidosis, with serum lactate levels of 22 mM). He was treated with sodium bicarbonate, insulin and thiamine after which he recovered within two days. Diabetic ketoacidosis and lactic acidosis aggravated due to ethanol intoxication, thiamine deficiency and citrate. The high lactate levels were explained by excessive lactate formation caused by the combination of untreated diabetes mellitus, thiamine deficiency and ethanol abuse. Metabolic acidosis in diabetes is multi-factorial, and the clinical situation may be further complicated, when ingestion of ethanol and toxic agents are involved. Here, we reported a patient in whom diabetic ketoacidosis was accompanied by severe lactic acidosis as a result of citric acid and mainly ethanol ingestion and a possible thiamine deficiency. In the presence of lactic acidosis in diabetic ketoacidosis, physicians need to consider thiamine deficiency and ingestion of ethanol or other toxins.

Topics: Acidosis; Acidosis, Lactic; Alcoholic Intoxication; Citric Acid; Diabetes Mellitus, Type 2; Humans; Insulin; Male; Middle Aged; Severity of Illness Index; Sodium Bicarbonate; Thiamine; Thiamine Deficiency