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Abstract: PO0099

Hand Sanitizer Overdose in the Era of COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Mettupalli, Neeharika, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Breithaupt, Ashton N., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Chedid, Alice, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
Introduction

Isopropyl alcohol is a common ingredient in hand sanitizers.Ingestion should be suspected if patient presents with high osmolar gap & pseudo renal failure without metabolic acidosis.

Case Description

44 y/o female with h/o of HTN & hypothyroidism,brought to the ED for altered mental status. 2 bottles of hand sanitizers were found empty next to her. She was drowsy, unable to provide any further history. Vitals T- 36.7 C, HR 91, BP 124/84, RR 14,SaO2 97 on RA. Physical exam was unremarkable. Initial labs on admission: Serum creatinine 2.47, i-stat creatinine at 0.7, bicarb 24, AG 8, serum osmolality 341, osmolar gap of 57. Ethanol level was negative. Table1 outlines the patient’s labs. Given normal bicarb, normal AG with very high osmolar gap, isopropyl alcohol ingestion was suspected. IV fomepizole was started,as some hand sanitizers contain methanol. Fomepizole was continued until osmolar gap closed. No dialysis was required. Methanol level was undetectable. Acetone level high 176. Isopropranol level high 49. Patient’s mental status improved with supportive measures.

Discussion

Isopropanol ingestion presents with normal bicarb, normal AG with very high OG. Treatment is usually supportive. Clinicians should be aware of falsely elevated serum cr if measured via colorimetric method due to acetone’s interference. Our case presents a new challenge added to numerous challenges physicians are facing in the COVID Era.

Labs
TESTRESULTReference range
sodium,mmol/l136136-145
Potassium,mmol/l5.53.5-5.1
Chloride,mmol/l10498-107
Bicarbonate,mmol/l2422-32
Blood urea Nitrogen,mg/dl97-18
Creatinine,mg/dl2.470.52-1.21
i-stat creatinine,mg/dl0.70.52-1.21
Glucose,mg/dl13265-99
Albumin,g/dl4.03.0-4.5
Lactate,mmol/l0.60.4-2
Serum Osmolality,mosm/kg341282-302
Serum Acetaminophen mcg/ml<2-
Serum Salicylate,mg/dl<1.710-30
Serum Ethanol,mg/dl<30
B-hydroxybutyrate0.40-0.29
Serum Acetone,mg/dl176-
Serum Isopropyl Alcohol,mg/dl490
Serum Methanolundetectable-
Serum Ethylene Glycol,mg/l<10-