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Вміст надано Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania. Весь вміст подкастів, включаючи епізоди, графіку та описи подкастів, завантажується та надається безпосередньо компанією Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania або його партнером по платформі подкастів. Якщо ви вважаєте, що хтось використовує ваш захищений авторським правом твір без вашого дозволу, ви можете виконати процедуру, описану тут https://uk.player.fm/legal.
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Approach Toxic Alcohol Ingestion in the PICU

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Manage episode 455554653 series 2873095
Вміст надано Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania. Весь вміст подкастів, включаючи епізоди, графіку та описи подкастів, завантажується та надається безпосередньо компанією Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania або його партнером по платформі подкастів. Якщо ви вважаєте, що хтось використовує ваш захищений авторським правом твір без вашого дозволу, ви можете виконати процедуру, описану тут https://uk.player.fm/legal.

Introduction

  • Hosts: Dr. Pradip Kamat (Children’s Healthcare of Atlanta/Emory University) and Dr. Rahul Damania (Cleveland Clinic Children’s Hospital)
  • Mission: A podcast dedicated to current and aspiring pediatric intensivists, exploring intriguing PICU cases and acute care pediatric management
  • Focus of the Episode: Managing toxic alcohol ingestion in the PICU with emphasis on ethanol, methanol, ethylene glycol, propylene glycol, and isopropyl alcohol

Case Presentation

  • Patient Details: A 7-month-old male presented with accidental ethanol ingestion after his formula was mixed with vodka
  • Key Symptoms: Lethargy, uncoordinated movements, decreased activity, and ethanol odor
  • Initial Labs & Findings:
  • EtOH level: 420 mg/dL.
  • Glucose: 50 mg/dL.
  • Normal CXR and EKG.
  • PICU Presentation: Tachycardic, normotensive, lethargic, with signs of CNS depression
  • Initial Management: Dextrose infusion, glucose monitoring, neurological observation, and ruling out complications

Key Learning Points from the Case

  • Toxic alcohol ingestion in pediatrics requires rapid stabilization and targeted interventions
  • Hypoglycemia and CNS depression are common features of ethanol toxicity in infants
  • Management prioritizes glucose correction, airway support, and close neurological monitoring

Deep Dive: Toxic Alcohols in the PICU

1. Ethanol

  • Typical Presentation in Infants/Toddlers: Hypotonia, ataxia, coma, hypoglycemia, hypotension, and hypothermia
  • Diagnostic Workup:
  • Focus on CNS and metabolic effects
  • Labs: Glucose, electrolytes, bicarbonate, anion gap, ketones, toxicology screen
  • Imaging (head CT) if indicated
  • Management: Stabilization, IV dextrose for hypoglycemia, NPO status until alert, and consultation with poison control and social work

2. Methanol

  • Sources: Windshield fluids, cleaning agents, moonshine
  • Clinical Stages:

  1. Early: Dizziness, nausea, vomiting (0–6 hours)
  2. Latent: Asymptomatic (6–30 hours)
  3. Late: Vision disturbances, seizures, respiratory failure (6–72 hours)

  • Key Symptoms: “Snowstorm blindness” from retinal toxicity
  • Management: Fomepizole, correction of metabolic acidosis, and hemodialysis in severe cases

3. Ethylene Glycol

  • Sources: Antifreeze, brake fluids, household cleaners
  • Pathophysiology: Metabolism to glycolic acid (acidosis) and oxalic acid (renal failure due to calcium oxalate crystals)
  • Red Flags: Hypocalcemia, renal failure, QT prolongation
  • Management: Fomepizole, supportive care, and hemodialysis for severe toxicity

4. Propylene Glycol

  • Sources: Medications like lorazepam and pentobarbital
  • Presentation: High anion gap metabolic acidosis at high doses, with renal and liver dysfunction
  • Management: Discontinue offending agent, supportive care, and hemodialysis if severe

5. Isopropyl Alcohol

  • Sources: Disinfectants, hand sanitizers
  • Presentation: CNS depression, GI irritation, fruity acetone breath, but no metabolic acidosis
  • Management: Supportive care; fomepizole and ethanol are ineffective

Key Laboratory Insights

  • Osmolar Gap Formula:
  • Measured Osmolality - Calculated Osmolality
  • A high osmolar gap indicates unmeasured osmoles like toxic alcohols.
  • Lactate Gap in Ethylene Glycol: Discrepancy between bedside and lab lactate levels due to glycolate interference

Management Pearls

  • Ethanol and Ethylene Glycol: Fomepizole as first-line treatment; hemodialysis for severe cases
  • Methanol: Similar approach with additional focus on preventing blindness
  • Propylene Glycol: Monitor lactate and renal function, discontinue offending medications
  • Isopropyl Alcohol: Supportive care, no acidosis present

Mnemonics for Toxic Alcohols

MEGA GAP:

  • Methanol and Ethylene Glycol: Anion Gap Acidosis with elevated Osmolar Gap
  • Isopropyl Alcohol: Isolated Osmolar Gap (no acidosis)
  • Propylene Glycol: Mimics ethylene glycol with HAGMA at high doses

Takeaway Messages

  • Early recognition of toxic alcohol ingestion is critical for successful management
  • Differentiate between toxic alcohols using anion gap, osmolar gap, and clinical presentation
  • Engage poison control and social work early in the process

Conclusion

  • Pediatric toxic alcohol ingestions are rare but potentially life-threatening
  • Fomepizole is a cornerstone therapy for methanol and ethylene glycol toxicity
  • Supportive care remains essential across all toxic alcohol ingestions

Connect with US!

Twitter: @PICUDocOnCall

Email: contact@picudoconcall.com

  continue reading

95 епізодів

Artwork
iconПоширити
 
Manage episode 455554653 series 2873095
Вміст надано Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania. Весь вміст подкастів, включаючи епізоди, графіку та описи подкастів, завантажується та надається безпосередньо компанією Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania або його партнером по платформі подкастів. Якщо ви вважаєте, що хтось використовує ваш захищений авторським правом твір без вашого дозволу, ви можете виконати процедуру, описану тут https://uk.player.fm/legal.

Introduction

  • Hosts: Dr. Pradip Kamat (Children’s Healthcare of Atlanta/Emory University) and Dr. Rahul Damania (Cleveland Clinic Children’s Hospital)
  • Mission: A podcast dedicated to current and aspiring pediatric intensivists, exploring intriguing PICU cases and acute care pediatric management
  • Focus of the Episode: Managing toxic alcohol ingestion in the PICU with emphasis on ethanol, methanol, ethylene glycol, propylene glycol, and isopropyl alcohol

Case Presentation

  • Patient Details: A 7-month-old male presented with accidental ethanol ingestion after his formula was mixed with vodka
  • Key Symptoms: Lethargy, uncoordinated movements, decreased activity, and ethanol odor
  • Initial Labs & Findings:
  • EtOH level: 420 mg/dL.
  • Glucose: 50 mg/dL.
  • Normal CXR and EKG.
  • PICU Presentation: Tachycardic, normotensive, lethargic, with signs of CNS depression
  • Initial Management: Dextrose infusion, glucose monitoring, neurological observation, and ruling out complications

Key Learning Points from the Case

  • Toxic alcohol ingestion in pediatrics requires rapid stabilization and targeted interventions
  • Hypoglycemia and CNS depression are common features of ethanol toxicity in infants
  • Management prioritizes glucose correction, airway support, and close neurological monitoring

Deep Dive: Toxic Alcohols in the PICU

1. Ethanol

  • Typical Presentation in Infants/Toddlers: Hypotonia, ataxia, coma, hypoglycemia, hypotension, and hypothermia
  • Diagnostic Workup:
  • Focus on CNS and metabolic effects
  • Labs: Glucose, electrolytes, bicarbonate, anion gap, ketones, toxicology screen
  • Imaging (head CT) if indicated
  • Management: Stabilization, IV dextrose for hypoglycemia, NPO status until alert, and consultation with poison control and social work

2. Methanol

  • Sources: Windshield fluids, cleaning agents, moonshine
  • Clinical Stages:

  1. Early: Dizziness, nausea, vomiting (0–6 hours)
  2. Latent: Asymptomatic (6–30 hours)
  3. Late: Vision disturbances, seizures, respiratory failure (6–72 hours)

  • Key Symptoms: “Snowstorm blindness” from retinal toxicity
  • Management: Fomepizole, correction of metabolic acidosis, and hemodialysis in severe cases

3. Ethylene Glycol

  • Sources: Antifreeze, brake fluids, household cleaners
  • Pathophysiology: Metabolism to glycolic acid (acidosis) and oxalic acid (renal failure due to calcium oxalate crystals)
  • Red Flags: Hypocalcemia, renal failure, QT prolongation
  • Management: Fomepizole, supportive care, and hemodialysis for severe toxicity

4. Propylene Glycol

  • Sources: Medications like lorazepam and pentobarbital
  • Presentation: High anion gap metabolic acidosis at high doses, with renal and liver dysfunction
  • Management: Discontinue offending agent, supportive care, and hemodialysis if severe

5. Isopropyl Alcohol

  • Sources: Disinfectants, hand sanitizers
  • Presentation: CNS depression, GI irritation, fruity acetone breath, but no metabolic acidosis
  • Management: Supportive care; fomepizole and ethanol are ineffective

Key Laboratory Insights

  • Osmolar Gap Formula:
  • Measured Osmolality - Calculated Osmolality
  • A high osmolar gap indicates unmeasured osmoles like toxic alcohols.
  • Lactate Gap in Ethylene Glycol: Discrepancy between bedside and lab lactate levels due to glycolate interference

Management Pearls

  • Ethanol and Ethylene Glycol: Fomepizole as first-line treatment; hemodialysis for severe cases
  • Methanol: Similar approach with additional focus on preventing blindness
  • Propylene Glycol: Monitor lactate and renal function, discontinue offending medications
  • Isopropyl Alcohol: Supportive care, no acidosis present

Mnemonics for Toxic Alcohols

MEGA GAP:

  • Methanol and Ethylene Glycol: Anion Gap Acidosis with elevated Osmolar Gap
  • Isopropyl Alcohol: Isolated Osmolar Gap (no acidosis)
  • Propylene Glycol: Mimics ethylene glycol with HAGMA at high doses

Takeaway Messages

  • Early recognition of toxic alcohol ingestion is critical for successful management
  • Differentiate between toxic alcohols using anion gap, osmolar gap, and clinical presentation
  • Engage poison control and social work early in the process

Conclusion

  • Pediatric toxic alcohol ingestions are rare but potentially life-threatening
  • Fomepizole is a cornerstone therapy for methanol and ethylene glycol toxicity
  • Supportive care remains essential across all toxic alcohol ingestions

Connect with US!

Twitter: @PICUDocOnCall

Email: contact@picudoconcall.com

  continue reading

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