(1418) Inhalation of Isopropyl Alcohol Leading to Acute Severe Toxicity: A Case Report

Introduction: Isopropyl alcohol toxicity is characterized by central nervous system depression without metabolic acidosis and usually occurs through accidental ingestion. While mild toxicity was reported through transdermal absorption, fatal toxicity was reported in neonates who accidentally inhaled nebulized rubbing alcohol. However, there have been no reports of severe intoxication due to inhalation of isopropyl alcohol in adults.

Description: A 69-year-old female with an insignificant medical history presented to the emergency department with altered mental status for the past two hours. Her family reported that she had taken a nap after using two bottles of rubbing alcohol to clean under the bed sheet to eliminate bed bugs.
Upon arrival, her vital signs were as follows: temperature 96.0 °F, heart rate at 96 , respiratory rate at 28 , blood pressure 110/73mmHg, and SpO2 97% on room air. The patient was unresponsive but arousable to pain stimuli, with no neck stiffness. Heart and lung sounds were normal, and the abdomen was soft and non-tender. A complete blood count, serum chemistries, arterial blood gas and urinalysis were unremarkable, and urine ketones and toxin screen were negative. Serum glucose was 117 mg/dL. Imaging studies included an unremarkable CT brain without contrast, CTA brain, and an MRI. EEG was suggestive of encephalopathy.
The patient was admitted to the intensive care unit due to severe altered mental status and was initially treated for a suspected systemic infection with empirical antibiotics but there was no clinical improvement. Serum osmolality was subsequently tested and revealed a marked osmolal gap of 65. Serum isopropyl alcohol was positive at 285mg/dL with positive serum ketone, while serum methanol and ethyl alcohol were not detected. A hemodialysis was initiated. Thirty minutes later, the patient became awake, and responsive. Follow-up laboratory tests showed a resolution high osmolal gap.

Discussion: Patients presenting with unexplained altered mental status should be further evaluated for isopropyl alcohol intoxication, regardless of history of ingestion. The osmolal gap is a valuable diagnostic tool in cases of toxic alcohol intoxication. Prompt hemodialysis is recommended if severe isopropyl intoxication is suspected to decrease the overall mortality rate.