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Abstract
A comatose and hypotensive patient was successfully treated with hemodialysis after ingesting 480 mL of isopropyl alcohol. Removal of isopropyl alcohol and its major metabolite acetone was measured in urine, blood, and dialysate. According to dialysate measurements, approximately 19 g of isopropyl alcohol and 7 g of acetone were removed per hour using a standard 1 m2 dialyzer. The average dialysance of isopropyl alcohol and acetone were 137 and 165 mL/min, respectively. Removal of isopropyl alcohol was 52 times and acetone 40 times more efficient through hemodialysis than through urinary excretion. Since coma and hypotension portend a bad prognosis and since urinary excretion is slow relative to hemodialysis removal, hemodialysis may be considered lifesaving in patients comatose from isopropyl alcohol poisoning.
There have been two previous reports of hemodialysis used for treatment of isopropyl alcohol intoxication [1, 2]. Neither of these reports describes the kinetics of isopropyl alcohol removal. This paper reports a third patient treated with hemodialysis who afforded us the opportunity to study blood, urine, and dialysate levels of isopropyl alcohol and its chief metabolite, acetone. By utilizing these results a comparison was made of urine excretion to dialysis removal of these compounds to compare their respective efficacy. In addition, the estimated removal by dialysance calculations was compared to estimated removal by measurement of dialysate volumes and concentrations.