Principle of managing intoxication

• ID toxidrome
• Supportive care ABCs (primary survey)
  • Give B1 - Thiamine : patine with alcohol history are often thiamin-deficient
• Decontamination (GI)
  • Gastric lavage or Activated charcoal don’t work for alcohol – quickly absorbed
  • Work for enteric coated pill, NSAID
• Neutralization – is antidote indicated
  • For Methanol or Ethylene glycol
    • Fomepizole ****or Ethanol ****(choose one)
    • Can start with ethanol – wait until fomepizole is found -> switch
• Elimination (Renal: HD - Hemodialysis → IHD)
  • *Dialysis may remove both Ethanol and Methanol
    • Add Ethanol to the dialysate
  • Re-dose Fomepizole ****more frequently
  • Duration: At least 8 hours
    • Prolonged dialysis needed: 8-12 hr
    • Until the toxin is < 5 mmol/L
      • Continue monitoring Q2h
    • Rebound effect:
      • Level goes down – stop dialysis – level goes back up in 1 hour
      • Some toxin stuck in the extravascular component