Management of toxic alcohol poisoning in New South Wales: a retrospective study

Toxic alcohol poisoning causes significant morbidity and mortality, especially when treatment is delayed. We describe the epidemiology, management and outcomes of clinically significant toxic alcohol poisonings in New South Wales. We also evaluate the frequency and choice of antidotal therapies (fomepizole versus ethanol) and complications of poisoning and treatment.

We searched databases of the New South Wales Poisons Information Centre, and six tertiary clinical toxicology services. We included toxic alcohol poisonings referred to a clinical toxicologist, which met the indications for treatment. Data extracted included demographics, exposures, management, and outcomes.

Among 259 patients presenting with suspected toxic alcohol poisoning between 2015 and 2023, 39 fulfilled the inclusion criteria. Ingestions included ethylene glycol (n = 31), diethylene glycol (n = 5), and methanol (n = 3). The median time to presentation was 4 h (IQR: 2-10 h; n = 23). The median time from hospital presentation to initiating alcohol dehydrogenase inhibition was 4 h (IQR: 2-6 h; n = 33). Five patients received fomepizole and 28 received ethanol therapy. In 23 patients receiving ethanol for ≥24 h, 10 (43%) had at least two subtherapeutic ethanol concentrations. Twenty-five patients received extracorporeal treatments, initiated within a median of 7 h (IQR: 4-11 h; n = 24). Twenty-two patients (56%) developed complications: acute kidney injury (n = 21), neurotoxicity (n = 10), and death (n = 4). In 18 ethanol-treated patients (64%), the use of fomepizole could have been advantageous, including avoiding intensive care admission (n = 8), simplifying monitoring during transport (n = 11), and delaying and/or foregoing extracorporeal treatment (n = 7).

Most patients treated for toxic alcohol poisoning had proven poisonings, biochemically or by history. Complications were common for multiple reasons, including possible delays in diagnosis and treatment.

The management of patients with toxic alcohol poisonings is resource-intensive, and toxicity is associated with clinically sig-nificant morbidity and mortality. Delays in presenta-tion, diagnosis and treatment initiation appear to be associated with the development of complications.