When is hemodialysis indicated in the treatment of alcohol toxicity?

Updated: Jan 05, 2021
  • Author: Michael D Levine, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Hemodialysis is frequently required in patients with significant methanol or ethylene glycol ingestions. [24, 28] Indications for hemodialysis include the following:

  • Arterial pH < 7.10
  • A decline of >0.05 in the arterial pH despite bicarbonate infusion
  • pH < 7.3 despite bicarbonate therapy
  • Rise in serum creatinine level by 90 mmol/L
  • Initial plasma methanol or ethylene glycol concentration ≥50 mg/dL

A number of case reports suggest that hemodialysis should be considered in the treatment of severe alcohol intoxication with serum ethanol levels > 450 mg/dL. Close monitoring is required when administering hemodialysis to patients with alcohol use disorder as alcohol withdrawal syndrome could be triggered by the rapid elimination of ethanol. [32]

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