Welcome back to the Internet Book of Critical Care.

I'm here with Adam Thomas and we're going to talk about ethylene glycol and methanol

poisoning.

Just because we haven't had a controversial post there in a while, we're going to start

off with the basics that everybody can accept and then maybe let's talk about a new way

to conceive of toxic alcohols and diverge a bit

from the classic double gap approach. So today we'll punchline the biochemistry. We'll move into

diagnostic strategy and then of course we'll cover treatment with blockade and potential

dialysis for elimination. So Josh biochemistry hit me up with the punchline that is a toxic alcohol

is only toxic if it has an acid that causes badness. Exactly. So methanol and ethylene

glycol can cause some toxicity. They can cause, you know, CNS suppression kind of similar to

standard ethanol. But by themselves, they're not that toxic. The real problem is when they get

converted into things like formic acid from ethanol and glycolic acid from ethylene glycol that cause all sorts of

more severe toxicities. So this creates kind of like this biphasic toxicity where initially

people may show up with methanol or ethylene glycol in their system and they're going to

appear inebriated and they may have elevated levels of these so-called parent alcohols. And then over time, those are going to get metabolized into the toxic formic acid and

glycolic acid metabolites.

And that's going to essentially shift the toxicity in clinical picture.

So we'll all have a parent molecule.

We all go to an aldehyde, and we go to an acid.

And hopefully we start eliminating things.

Exactly.

...