Toxic Alcohol Ingestion

This case is written by Dr. Kyla Caners. She is a staff emergency physician in Hamilton, Ontario and the Simulation Director of McMaster University’s FRCP-EM program. She is also one of the Editors-in-Chief here at EmSimCases.

Why it Matters

While toxic alcohol ingestions requiring treatment are relatively rare, patients presenting with a profoundly altered mental status are not. This case highlights key features of each, including:

  • The need for a broad differential in patients with an altered mental status (especially when there is absolutely no relevant history available!)
  • The importance of identifying and working through causes of an anion gap metabolic acidosis
  • The empiric and definitive treatments of a toxic alcohol overdose

Clinical Vignette

EMS has just brought you to a patient with a GCS of 3. He was found in the back alley behind a drug store with no identifying information. He is not known to EMS or to your department. He appears to be in his 30s or 40s.

Case Summary

A 46 year-old male presents with a GCS of 3 after being found in the back alley behind a drug store. The team will need to work through a broad differential diagnosis and recognize the need to intubate the patient. If they try naloxone, it will have no effect. After intubation, the team will receive critical VBG results showing a profound metabolic acidosis with a significant anion gap. The goal is to trigger the team to work through the possible causes of an elevated anion gap, including toxic alcohols.

Download the case here: Toxic Alcohol Case

ECG for the case found here:

Sinus tachycardia

(ECG source:

Post-intubation CXR for the case found here:

Post Intubation

(CXR source:

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