Presentation
Commercially available spirits ~ 40%
Role
Management of suspected or known toxic alcohol poisoning in consultation with a clinical toxicologist.
Consultation with a clinical toxicologist is recommended through local toxicology service or Poisons Information Centre 13 11 26.
Dose
Oral/nasogastric
Loading dose 0.6g/kg
- Maintenance dose 5-10g/h
- Aim for BAL 0.1-0.2 g/dL or serum ethanol of 22-44mmol/L. Measure serum ethanol level 1-2 hourly and adjust maintenance dose as needed. Doses will need to be doubled if the patient is receiving haemodialysis.
- 30ml = 10g ethanol
For the averaged size adult:
- Load: 4-6 x 30mL shots
- Maintenance: 0.5 – 1 shot per hour
Stocking recommendations
| Tertiary centre | Regional centre | Rural centre | Remote centre |
|---|---|---|---|
| 1 bottle of spirits | 1 bottle of spirits | 1 bottle of spirits | 1 bottle of spirits |
Rationale
Whilst IV ethanol is available as an alternative, it is both more expensive and more complicated to administer. Nasogastric administration of ethanol is effective and may deliver ethanol more effectively to the liver. Commercially available spirits are readily available. In children, fomepizole is the preferred antidote – alcohol can be used whilst the child is transferred to a centre that stocks this (see Fomepizole monograph).
Precautions
- Hypoglycaemia may occur, especially in children.
- Higher maintenance rates are needed in those with chronic alcohol abuse.
Disclaimer
Fact sheet developed by Queensland Poisons Information Centre.
This fact sheet is about the use of these antidotes in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this fact sheet.