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[Isopropanol and acetone level in serum after preoperative surface disinfection with antiseptics containing
S Wittmann1, T Gilg, H G Dietz
1Institut für Rechtsmedizin, Universität München.
Insights
Preoperative skin disinfection in children can elevate serum isopropanol and acetone levels, potentially interfering with alcoholism marker tests. This highlights the need to consider disinfectant use when interpreting toxicological results.
Area of Science:
- Toxicology
- Clinical Chemistry
- Pediatric Surgery
Context:
- Preoperative skin disinfection is standard practice in pediatric surgery.
- Isopropanol and acetone are commonly found in skin disinfectants.
- Elevated serum acetone can occur preoperatively due to starvation.
Purpose:
- To investigate the impact of preoperative skin disinfection on serum levels of isopropanol and acetone in pediatric surgical patients.
- To assess potential confounding effects on toxicological markers.
Summary:
- Serum isopropanol levels increased after skin disinfection due to percutaneous absorption.
- Serum acetone levels also rose post-disinfection in most cases.
- These elevations may mimic or interfere with the interpretation of alcoholism markers.
Impact:
- Findings necessitate caution when interpreting isopropanol and acetone levels in patients undergoing skin disinfection.
- Results are relevant for forensic toxicology, particularly in accident victims.
- Highlights the importance of considering iatrogenic factors in clinical toxicology.
Abstract:
After preoperative skin disinfection in pediatric surgery, serum levels of isopropanol up to 12.2 mg/l (MW 5.0 mg/l +/- 3.37, n = 26) were found. They result from a rapid and prolonged but uncharacteristic percutaneous resorption of the isopropanol-containing disinfectant. In about 50% of the cases, serum levels of acetone showed an increase up to 82 mg/l already before skin disinfection, presumably caused by preoperative starvation. After skin disinfection, raised acetone levels were found in 19 of 26 cases. As increased isopropanol and acetone levels are discussed as alcoholism markers, a falsification of congener analysis after skin disinfection, e.g. in cases of adult victims of accidents, has to be taken into consideration. Endogenous serum levels of methanol (0.87 mg/l +/- 0.49), ethanol (0.32 mg/l +/- 0.09), acetaldehyde (0.31 mg/l +/- 0.10) and others remained unaffected. Some uncharacteristic elevations of propanol-1 levels are caused by contaminated rubber caps.