Isopropyl Alcohol Ingestion Presenting as Pseudorenal Failure Due to Acetone Interference

Mahathi R. Adla, MD; Julio A. Gonzalez-Paoli, MD; Stephen I. Rifkin, MD, FACP, FASN

Disclosures

South Med J. 2009;102(8):867-869. 

In This Article

Abstract and Introduction

Abstract

Isopropyl alcohol is a relatively common source of clinical intoxication. It is usually suspected when a patient presents with high serum or urine ketones and a high osmolar gap without acidosis. Acute renal failure due to isopropyl alcohol ingestion is rare. We describe a patient with isopropyl alcohol ingestion who presented with renal failure, but with a false elevation of serum creatinine secondary to interference by acetone with the colorimetric assay for creatinine. We highlight the use of blood gas analyzers, which use an enzymatic assay, thus avoiding acetone interference, as a quick method to correctly estimate the serum creatinine concentration and avoid labeling the patient as having acute renal failure.

Introduction

Isopropyl alcohol (IPA) or isopropanol (CH3CHOCH3) is commonly used as a deicer, cleaning agent, and as a solvent in rubbing alcohol. It is readily available and most toxic ingestions are in children after accidental intake. In adults, most ingestions are in alcoholics, as a substitute for ethyl alcohol, or in attempted suicides.[1] IPA is a central nervous system inebriant and depressant, and patients can present in an intoxicated state with laboratory evaluation revealing ketonuria with a high osmolar gap without metabolic acidosis.[2,3] We describe a case of IPA ingestion causing a spurious elevation in serum creatinine due to the interference of acetone with the colorimetric assay. We also discuss a quick way to detect such an error using a blood gas analyzer.

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