In clinical practice, poisoning with ethylene glycol, methanol, and isopropyl alcohol is common. These alcohol-related intoxications can present with high anion gap metabolic acidosis and increased osmolality. Toxicity and clinical symptoms are due to the accumulation of their metabolites, causing increased anion gap, rather than the parent compounds that are associated with an increase of serum osmolality. Clinical manifestations result from abnormalities of neurologic, cardiopulmonary, and renal function. Laboratory abnormalities when present are helpful for diagnosis but may be absent depending on the time of ingestion and time of presentation. Fomepizole and ethanol are potent inhibitors of alcohol dehydrogenase and reduce generation of toxic metabolites. Hemodialysis is an effective way of detoxification because it can remove unmetabolized alcohol in addition to the organic anions. High index of suspicion and early diagnosis can prevent the significant morbidity and mortality associated with these intoxications.
