Version July 2025
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222, or the nearest international regional poison center. Contact information for regional poison centers around the world is available at the website referenced below.[1] |
| Prepare 10% infusion¶[2,3] |
| 1. Withdraw 100 mL of fluid from 1 liter of 5% dextrose water (D5W). |
| 2. Replace with 100 mL of 98% dehydrated alcohol (ethanol) injection solution, USP (preservative- and bacteriostat-free) to create a 10% ethanol solution. |
| 3. Check vials/ampules. In some countries, pharmaceutical grade 95% ethanol is available. Do NOT use denatured alcohol or any other type of alcoholΔ. |
| 4. Prior to dilution, dehydrated alcohol injection should be purified through a 0.22 micron filter because these solutions may not be pyrogen-free. |
| Loading dose |
| Infuse 10 mL/kg of 10% ethanol over 60 minutes to raise serum ethanol concentration by about 100 mg/dL (22 mmol/L)¶. |
| Maintenance dose |
| 1. Following administration of the loading dose, begin maintenance infusion of 10% ethanol solution at 1 mL/kg per hour. |
| 2. Titrate infusion rate to maintain serum ethanol concentration of approximately 100 mg/dL (22 mmol/L) based on serial ethanol concentrations measured initially every 1 to 2 hours. |
| 3. Actual maintenance dose requirements vary from 0.8 mL/kg per hour to 2 mL/kg per hour (and higher still during hemodialysis)◊. |
| 4. Once serial measurements demonstrate stable ethanol serum levels of ≈ 100 mg/dL (22 mmol/L), frequency of measurements may be decreased to every 2 to 4 hours. |
| 5. Larger toxic ingestions may warrant targeting a higher serum ethanol concentration goal of up to 150 mg/dL (33 mmol/L)§. |
| 6. Continue maintenance infusion until either serum methanol or ethylene glycol concentration is undetectable (in patients with end-organ toxicity) or ≤20 mg/dL (SI units: methanol ≤6.2 mmol/L; ethylene glycol ≤3.2 mmol/L) and patient is asymptomatic and with a normal pH. Two or more days of ethanol infusion may be required, depending upon amount of ingestion, toxicity, and use of hemodialysis. |
* NOTE: Fomepizole is preferred antidotal therapy. Ethanol shown in this table is an alternate option when fomepizole is unavailable or when there is a history of a severe adverse reaction due to fomepizole warranting its avoidance. Refer to UpToDate topic.
¶ Prepared as above, a 10% (volume to volume) ethanol solution provides approximately 0.8 grams of ethanol per 10 mL. A 10 mL/kg loading dose therefore provides ≈ 0.8 grams ethanol/kg. 10% ethanol solution is hyperosmolar (1700 mosm/L) and can cause phlebitis. Central venous catheter administration using an infusion pump is therefore preferred when feasible.
Δ When pharmaceutical grade ethanol is not available, alcoholic beverages can be substituted; a 20% ethanol solution (eg, 80 proof or 40% [volume to volume] diluted in an equal volume of D5W) can be administered orally or via a nasogastric tube at half the volumes recommended herein for a 10% intravenous infusion.
◊ Rate of elimination of ethanol is subject to wide inter-individual variability and is generally increased in male patients and those who consume alcohol chronically. Typical clearance rates are 15 to 20 mg/dL/hour (3.3 to 4.3 mmol/L per hour). The half-life of ethanol increases as serum levels rise such that small adjustments to dose can produce disproportionate changes in ethanol serum concentrations. Ethanol dose requirement are increased by about 50% during hemodialysis.
§ The targeted ethanol serum concentration should be at least one quarter of the serum methanol or ethylene glycol concentration as measured in conventional (mg/dL) units. Refer to UpToDate topic for empiric adjustment.
