Fomepizole fails to prevent progression of acidosis in 2-butoxyethanol and ethanol coingestion.
BACKGROUND
2-butoxyethanol (2BE) is a solvent commonly incorporated into household and industrial cleaning products. Its ingestion causes rapid central nervous system depression, hypotension, and metabolic acidosis attributable to metabolism of the parent compound to butoxyacetic acid (BAA) by alcohol dehydrogenase. Lactic acidosis is also reported to develop in some cases. Published treatment strategies include the use of ethanol infusion, ethanol with concomitant dialysis, dialysis alone, and fomepizole.


METHODS
We present an unusual case of a coingestion of ethanol and 150-250 mL of pure 2BE, which resulted in rapid obtundation, severe airway edema, hypotension, and prolonged acidosis despite the coingestion of ethanol and the administration of a loading dose of fomepizole. Continuous veno-venous hemodialysis was employed to treat the acidosis. Ingestion was confirmed by gas chromatography and mass spectrometric determinaiton of 2BE and BAA. The patient recovered without sequelae.


CONCLUSIONS
Alcohol dehydrogenase inhibitors may not be adequate to prevent acidosis in significant ingestions to 2BE and extracorporeal treatments may be necessary.
Hung
Tawny
T
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Dewitt
Christopher R
CR
Martz
Walter
W
Schreiber
William
W
Holmes
Daniel Thomas
DT
D000138:Acidosis / Q000188:drug therapy*; D000426:Alcohol Dehydrogenase / Q000037:antagonists & inhibitors*; D000931:Antidotes / Q000627:therapeutic use*; D018450:Disease Progression; D000431:Ethanol / Q000008:administration & dosage*; D005026:Ethylene Glycols / Q000008:administration & dosage / Q000506:poisoning*; D000077604:Fomepizole; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000627:therapeutic use*; D006435:Renal Dialysis
D000931:Antidotes; D005026:Ethylene Glycols; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000426:Alcohol Dehydrogenase; C017096:n-butoxyethanol