Acute Alcohol & Toxic-Alcohol Poisoning — Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Ethanol or toxic alcohol
   Plain ethanol, or suspected toxic alcohol (methanol/ethylene glycol)? (Ethanol intoxication: dysarthria, ataxia, drowsiness to coma; high levels can cause respiratory depression, aspiration, hypoglycemia. Clues to toxic alcohol: high-anion-gap metabolic acidosis + raised osmolar gap (>10–25); methanol → visual disturbance/blindness, ethylene glycol → renal injury/calcium oxalate crystals.)
   • Plain acute ethanol intoxication → Acute ethanol intoxication
   • Suspected toxic alcohol (methanol/ethylene glycol) → Suspected toxic alcohol
2. [End] Acute ethanol intoxication
   Mainly supportive — airway protection to prevent aspiration, monitoring, fluids; check and correct hypoglycemia; in chronic alcohol use give thiamine before glucose (prevent Wernicke encephalopathy); observe until awake, watch for co-existing trauma/poisoning and subsequent withdrawal. Usually self-limited.
3. [End] Suspected toxic alcohol
   1) Antidote: fomepizole (competitively inhibits alcohol dehydrogenase, blocking formation of toxic metabolites); ethanol as a substitute if fomepizole is unavailable. 2) IV sodium bicarbonate for severe acidosis. 3) Hemodialysis indications: severe high-anion-gap acidosis, end-organ damage (vision/kidney), very high levels, refractory acidosis (EXTRIP). 4) Cofactors: folinic acid/folate for methanol, thiamine/pyridoxine for ethylene glycol. Consult a poison center/toxicology.

Source guidelines & references

• Toxic alcohol (methanol/ethylene glycol) poisoning and EXTRIP dialysis indications
• Supportive care of acute ethanol intoxication (including thiamine before glucose)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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