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

Case Report

A 29-year-old Caucasian male was admitted with altered mental status and acute renal failure. He was supposedly found stuporous by his roommate and was brought to the emergency room. By the time the emergency room physician examined him, which was about three hours later, he was more awake and denied any ingestion. His physical exam was unremarkable. Chemistry studies were negative except for a serum creatinine of 2.2 mg/dL (as measured by UniCel® DxC 800 Synchron® Clinical System, Beckman Coulter Inc, Fullerton, CA, USA) with a blood urea nitrogen (BUN) of 7 mg/dL. Urinalysis showed 3 white blood cells, 6 red blood cells, ketones and no protein. A toxicology screen was positive for opiates. Serum osmolality was 375 mOs/kg and the osmolar gap was calculated to be 85 mOs/kg. A serum acetone level was 266 mg/dL. Methanol, ethylene glycol and isopropyl alcohol levels were ordered, and the patient was admitted to the intensive care unit, where he was empirically treated with fomepizole.

Past medical history was significant for multiple admissions for altered mental status, acute renal failure, low back pain, and hematuria. He had an extensive evaluation including negative computed tomography and magnetic resonance imaging studies of his abdomen/pelvis and a negative cystoscopy. During one of his previous admissions, the patient had admitted to ingesting isopropyl alcohol. The previous admissions were similar in presentation with an elevated serum creatinine between 2-3 mg/dL that would subsequently decrease to normal with conservative management within 3-4 days.

On day #2, the serum creatinine was 2.0 mg/dL with a BUN of 4 mg/dL. The serum osmolality was 339 mOs/kg with a calculated osmolar gap of 46 mOs/kg. A relatively simultaneous serum creatinine measured using the Stat Profile® Critical Care Xpress blood gas analyzer (Nova Biomedical, Waltham, MA), which utilizes an enzymatic method, revealed a serum creatinine of 0.8 mg/dL. An isopropyl alcohol level from the day of admission came back elevated at 100 mg/dL. By the fourth day, the patient's serum creatinine had decreased to 0.9 mg/dL as measured on the basic metabolic panel by our lab's standard auto analyzer using the colorimetric assay. The patient was discharged with outpatient psychiatric follow up scheduled.

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