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Isopropyl Alcohol Intoxication

William B. Van de Graaff, MD; W. Leigh Thompson, MD, PhD
Arch Intern Med. 1978;138(5):826. doi:10.1001/archinte.1978.03630290106041.
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To the Editor.—  Dr Berlin stated in his excellent editorial (Archives 137:993-994, 1977) that "cyanide intoxication and diabetes mellitus" may be "the only two major clinical situations with very high levels of serum acetone and acetone bodies." Isopropyl alcohol (isopropanol) intoxication also causes high concentrations of blood acetone and is about ten times more common at our institution (Case Western Reserve University, Cleveland) than treatable cyanide poisoning. Isopropyl alcohol is metabolized to acetone by liver alcohol dehydrogenase, and the acetone is metabolized and excreted by the kidneys and lungs.1 Urine and blood tests for acetone become strongly positive after isopropyl alcohol ingestion, though acidosis is uncommon. Ashkar and Miller2 described two diabetic patients who were "alcohol" abusers; they had persistent ketosis without acidosis, which resolved after eliminating their access to rubbing alcohol. The high concentrations of acetone are a reflection of the relative nontoxicity of isopropyl alcohol—blood concentrations


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