The diagnosis of toxic alcohols is a particularly controversial topic, based on recent evidence that the osmolal gap has a fairly awful sensitivity and specificity. This chapter describes an approach to toxic alcohol diagnosis which doesn't depend on the osmolal gap. Although this may seem radical, this strategy has been previously recommended by other authors (Koyfman et al 2018 & Gussow 2019).
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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If giving ethanol, would you need to shoot for a higher blood alcohol level in people who are chronic heavy drinkers, who would consistently have blood alcohol levels >200mg/dL?
Very interesting! I’m a critical care specialist for cats and dogs and lots of information on IBCC that are relevant to my veterinary patients so thank you! Fomepizole is very expensive and not often available for our patients so most of the time, we use ethanol. There is no fun on having a drunk dog in the ICU! 😛