Rubbing alcohol, a clear liquid found in most homes, is used widely as an antiseptic for minor cuts or a general surface cleaner. Although a fixture in first-aid kits, it is not meant for consumption and poses a severe threat if ingested. This common household product contains isopropyl alcohol. Drinking even a small amount initiates a rapid, life-threatening chain of events, requiring immediate medical intervention, as its toxic effects are far more potent than those caused by beverage alcohol.
Defining Isopropyl Alcohol Poisoning
Isopropyl alcohol (isopropanol) is the primary chemical component in rubbing alcohol, typically sold in concentrations of 70% or 91% mixed with water. This compound is chemically distinct from ethanol, the alcohol found in beverages, and is significantly more toxic. A potentially lethal dose for an adult is estimated to be as little as 250 milliliters of the 70% solution.
Isopropanol is the most commonly reported toxic alcohol ingestion to poison control centers, often involving accidental ingestion by young children or intentional misuse. The body absorbs isopropanol rapidly from the gastrointestinal tract, with blood concentrations peaking within 30 minutes to three hours after ingestion.
The Body’s Toxic Reaction
Once ingested, isopropanol travels to the liver, where the enzyme alcohol dehydrogenase breaks it down into its primary byproduct: acetone. Acetone is the same chemical found in many nail polish removers and is a potent central nervous system (CNS) depressant.
The resulting acetone is responsible for the prolonged state of intoxication and altered mental status observed in poisoning cases. Unlike other toxic alcohols, isopropanol metabolism does not typically produce severe metabolic acidosis. Instead, a hallmark of this poisoning is the presence of acetone in the blood and urine without a corresponding build-up of acidic compounds, often called “ketosis without acidosis.”
Immediate Physical Effects of Ingestion
The immediate physical effects of drinking rubbing alcohol are severe. Because isopropanol is roughly twice as potent as ethanol, the onset of severe central nervous system (CNS) depression is rapid and profound. Initial signs include dizziness, slurred speech, and uncoordinated movement, quickly escalating to stupor, unresponsiveness, and deep coma.
A primary concern is the depression of the respiratory drive, which can lead to dangerously slow or shallow breathing. As the CNS becomes overwhelmed, the body’s involuntary functions slow down, putting the individual at risk of respiratory arrest. The fruity odor of acetone may become noticeable on the person’s breath.
Ingestion also causes severe irritation and damage to the gastrointestinal tract. Patients frequently experience intense abdominal pain, nausea, and forceful vomiting, which may include blood (hemorrhagic gastritis). The chemical’s corrosive effect can cause chemical burns to the mucous membranes of the mouth, throat, and esophagus.
Systemic effects include cardiovascular and thermoregulatory dysfunction. Isopropanol acts as a vasodilator, leading to hypotension (low blood pressure) and sometimes tachycardia (rapid heart rate). The body’s ability to maintain its core temperature is impaired, resulting in hypothermia. This combination of CNS, respiratory, and cardiovascular depression can rapidly lead to shock and organ failure.
Critical Emergency Response and Treatment
Immediate action is necessary upon the discovery or suspicion of rubbing alcohol ingestion. The first step is to call for emergency medical services or contact a poison control center immediately. Providing details about the amount consumed and the specific product ingested is extremely helpful for medical professionals.
While waiting for help, do not attempt to induce vomiting, as this can cause further injury to the esophagus and increase the risk of aspiration. If the person is conscious and able to swallow, they can be given a small amount of water or milk, unless they are vomiting or have a decreased level of consciousness. The priority is maintaining an open airway and monitoring the person’s breathing.
Once in a medical setting, treatment is primarily supportive, focusing on stabilizing the patient’s vital functions. This involves close monitoring of blood pressure, heart rate, and respiratory status, often requiring intravenous fluids to address dehydration and hypotension. Oxygen therapy may be initiated if breathing is compromised, and mechanical ventilation may be necessary in severe cases.
Specialized interventions are reserved for the most severe poisonings. Hemodialysis, a procedure that filters the blood, can be used to rapidly remove both isopropanol and its metabolite, acetone, from the bloodstream. Unlike poisoning from methanol or ethylene glycol, enzyme-blocking antidotes like fomepizole are typically not indicated for isopropanol intoxication.