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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

Authors

  • 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
Introduction

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.

Discussion

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.