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Abstract: PO1126

Role of Hemodialysis in Severe Ethanol Poisoning

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Driscoll, Devin, Boston Medical Center, Boston, Massachusetts, United States
  • Bleecker, Griffin, Boston University Medical Campus, Boston, Massachusetts, United States
  • Zhen, Aileen W., Boston Medical Center, Boston, Massachusetts, United States
  • Francis, Jean M., Boston Medical Center, Boston, Massachusetts, United States
  • Jaberi, Aala, Boston Medical Center, Boston, Massachusetts, United States

The treatment for acute ethanol intoxication remains largely supportive. About 1% of patients presenting with ethanol intoxication require the utilization of critical care resources. We present a case of a 19-year-old with altered mental status and a serum ethanol level above assay who required hemodialysis for rapid ethanol elimination and made a full recovery.

Case Description

A 19-year-old male with no past medical history presented with unresponsive after a night of heavy ethanol use. His serum ethanol level was above assay at >550mg/dL. Methanol and ethylene glycol levels were undetectable. He had normal kidney and liver blood tests, without metabolic acidosis. His osmolar gap was attributed purely to ethanol. Given a Glasgow Coma Scale of 3, he was intubated for airway protection. He then developed atrioventricular dissociation and required atropine, and hypotension requiring vasopressor support. A repeat serum ethanol level at 9 hours remained above assay at >550mg/dL and he remained unresponsive at 14 hours. Decision was made to initiate patient on hemodialysis. Two hours into his hemodialysis session, he became conscious and was successfully extubated at a serum ethanol level of 260mg/dL. His neurologic status returned to baseline and he was discharged from the hospital within 24 hours.


The patient’s ethanol metabolism elimination rate without hemodialysis was calculated to be at 15mg/dL/hour. Using this elimination rate, his initial serum ethanol level was predicted to be about 634mg/dL. Without hemodialysis, it would take roughly 41 hours for complete elimination. While on dialysis, the patient's rate of elimination increased by a factor of four from 15mg/dL/hr to 56mg/dL/hr. Complications of prolonged intubation and cardiac and neurologic toxicity from severe ethanol poisoning in this young patient include life-threatening arrhythmias, and possible permanent neurologic damage which was avoided using hemodialysis to expedite ethanol elimination. This case demonstrates the role and benefit of hemodialysis for a critically ill patient who is experiencing organ toxicity and exposes a need for updated recommendations in this specific set of patients.