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25 Cards in this Set
- Front
- Back
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Methanol metabolism |
Methanol ADH Formaldehyde ALH Formic acid |
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Ethylene glycol metabolism |
Ethylene glycol ADH Glycolaldehyde aldehyde dehydrogenase Glycolic acid * Oxalic acid |
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Glycolic acid metabolism can follow 3 pathways |
Oxalic acid Glycine (via thiamine) Ketoadipic acid (via pyridoxine) |
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How does inhalation and dermal exposure differ between methanol and ethylene glycol |
Methanol can be absorbed via inhalation and dermal exposures. Ethylene glycol has very poor dermal absorption and cannot be inhaled. |
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Half life of EG and methanol |
EG - 11-18 hours Methanol 30-54 hours |
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What ethanol level is needed to preferentially bind ADH
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100 mg/dL |
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How does the NADH/NAD ratio effect lactate |
Metabolism of alcohols generates NADH. Increased NADH/NAD ratios favor the generation of lactate from pyruvate |
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"Lactate gap" |
EG can cause falsely elevated lactate levels on arterial blood gas analyzers. Lactate gap is difference between lactates with and without sensitization to glycolic acid. |
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Dose of fomepizole |
15mg/kg followed by 10mg/kg every 12 hours |
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Why does the dose of fomepizole need to be increased after 48 hours |
Fomepizole induces its own metabolism at 48 hours |
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What vitamin may enhance formate elimination |
Folate |
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What vitamins may enchance glycolic acid elimination |
Pyridoxine Thiamine |
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Role of urinary alkalinization in methanol toxicity |
No overwhelming evidence but generally recommended. Alkaline environment will increase formate to formic acid ratio. Increases formate clearance via ion trapping. Acidosis has been associated with worse neurological outcomes. |
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Metabolism of propylene glycol forms what product |
Lactate but generally it is well tolerated |
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"Neonatal gasping" syndrome involves what alcohol |
Benzyl alcohol (a common preservate). |
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How is hippuric acid formed and what neonatal condition is it associated with |
Metabolism of benzyl alcohol forms hippuric acid. Associated with neonatal gasping syndrome. |
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Elixir Sulfanilamide Disaster of 1937 |
Diethylene glycol used as diluent in elixir resulting in 105 deaths. Resulted in the 1938 Food, Drug, and Cosmetic Act - regulating the formulation and safety of medicinal products |
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3 historical incidents resulting in massive DEG-related deaths |
Panama (2006) DEG diluent in cough syrup Haiti (1996) - DEG used as diluent in paracetamol Elixir Sulfanilamide Disaster of 1938 |
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DEG can primarily effect what 2 main organ systems |
Renal and CNS |
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Common electrolyte abnormality seen with EG |
Hypocalcemia |
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Metabolic abnormality associated with isopropyl alcohol toxicity |
Ketosis without acidosis |
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Osmolar gap |
2Na + BUN/2.8 + glucose/18 + EtOH/4.6 |
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Effect of adminstrating fomepizole to drunk patient (ethanol only) |
Prolonged intoxication. Fomepizole has much higher affinity for ADH than ethanol |
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Typical MW for polyethylene glycol solid and liquid forms. How do they compare in terms of toxicity |
< 600. Liquid and toxic > 1000. Solids and non-toxic |
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Xenobiotics causing disulfiram-like reaction |
Carbon disulfide Disulfiram Thiram |
