Welcome to the Emergency Medicine Cases podcast with your host, Dr. Anton Hellman,

bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.

I've had a case every day this week.

A low osmolar gap does not rule out a toxic alcohol exposure.

The evidence for giving bicarb isn't based on huge randomized control trials.

Really?

I would stand at the foot of the bed and calculate the patient to respirate myself.

And they would prefer to just go steal our hand sanitizer than they would to go and use methanol.

Incredibly well explained.

For the most part, these patients come in as an enigma,

and it's a couple of hours before we are

sure that this was a toxic alcohol exposure.

Tough topic to tackle.

It's going to be your great case of your career when you have that patient come in.

We see patients with toxic alcohol poisoning most commonly in three clinical scenarios. One, which is usually relatively straightforward after an intentional suicide attempt where they tell you

exactly what they took. The next scenario is a lot more challenging when they come in just agitated

and they won't give you a history. And then the third, even more challenging is the inebriated

patient found down. Now, alcohol is everywhere and inevitably

inebriated people show up in your ED with a myriad of medical and psychiatric problems.

We're all familiar with these patients, or they're simply very drunk. And most of them just need to

sober up and then can eventually be sent home.

But our job as ED professionals is not only to identify traumatic, medical, and psychiatric catastrophes in these patients, but also to identify and manage the relatively rare but potentially

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