What is the prevalence of isopropanol, methanol, and ethylene glycol alcohol toxicity?

Updated: Jan 05, 2021
  • Author: Michael D Levine, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

In 2019, 14,269 single exposures to isopropanol (from sources including rubbing alcohol, cleaning agents, and hand sanitizers) were reported to US Poison Control Centers. Of these, 71 patients were classified as experiencing "major" morbidity, but no deaths were reported. [12]

In the same year, 1536 single exposures to automotive products containing methanol were reported resulting in 5 major outcomes and 5 deaths. [12]   There were 6739 exposures to ethylene glycol in automotive products, including antifreeze, reported in 2019. For those patients, 134 patients were classified as having "major" disability, with an additional 12 patients dying. [12] It is important to recognize that these numbers likely underestimate the true incidence of exposure, however, because of both a failure to recognize the ingestion as well as a failure to report the suspected or known ingestion to a poison control center.

Most cases of methanol toxicity involve single patients. Rarely, outbreaks may occur in settings where access to ethanol is limited and methanol is consumed as a substitute. Collister et al reported a methanol outbreak resulting from recreational ingestion of fracking fluid. [17]   In 2019 a total of 710 cases of menthanol toxicity from non-automotive or cleaning products was reported with 16 major outcomes and 11 deaths. [12]  

Among those cases was a cluster of 15 reports of methanol posioning from swallowing hand sanitizer in Arizona and New Mexico from May 1 to June 30, 2020. Four patients died and three more suffered visual impairment in the outbreak. [18]  An investigation by the US Food and Drug Administration subsequently identified 67 alcohol-based hand sanitizer products that contained methanol, triggering a consumer alert and product recall. [19]

The primary toxicity with isopropanol is CNS depression. These CNS manifestations can include lethargy, ataxia, and coma. In addition, isopropanol is irritating to the GI tract. Therefore, abdominal pain, hemorrhagic gastritis, and vomiting can be observed. Unlike methanol and ethylene glycol, isopropanol does not cause a metabolic acidosis.

The toxicity with methanol occurs from both the ensuing metabolic acidosis, as well as the formate anion (formic acid) itself. [20] Although the eye is the primary site of organ toxicity, in the later stages of severe methanol toxicity, specific changes can occur in the basal ganglia as well. Pancreatitis has been reported following methanol ingestion. Hyperventilation will occur as a compensatory mechanism to counteract the acidosis.

As previously stated, ethylene glycol itself is nontoxic. The majority of the metabolic acidosis occurs from glycolic acid. One form of morbidity occurs when oxalate combines with calcium to form calcium oxalate crystals, which accumulate in the proximal renal tubules, thereby inducing renal failure. Hypocalcemia can ensue, and cause coma, seizures, and dysrhythmias. Autopsy studies have confirmed that the calcium oxalate crystals are deposited not only in the kidneys but in many other organs, including the brain, heart, and lungs.


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