EBM Consult

Isopropanol Toxicology - An Overview


  • Isopropanol toxicity is important to recognize because it can cause inebriation as well as a potential risk for hemorrhagic gastritis.
  • Treatment is usually supportive, but may consider proton pump inhibitor use if GI bleed is a concern.

  Anthony J. Busti, MD, PharmD, FNLA, FAHA
Last Reviewed: August 2015

Isopropanol Toxicology


    • Isopropyl Alcohol
    • Rubbing Alcohol
    • Hand sanitizers
    Toxic Acid
    • None
      • Isopropanol does not get metabolized to a toxic acid metabolite like ethylene glycol and methanol.

    • Inebriation (Intoxication)
    • GI (rarely, Hemorrhagic gastritis)
    Metabolic Pathway


    Isopropanol Metabolism to Acetone Image 


    Lab Findings

    • Normal anion gap
    • Elevated osmol gap
    • Normal arterial pH
    • False elevations in serum creatinine
      • Isopropanol gets metabolized to acetone, which can interfere with colorimetric creatinine assay, especially those using the Jaffe alkaline picrate reaction.
      • BUN & GFR remains normal
    Conversion Factor

    • Conversion Factor = 6.0
    • How to estimate isopropanol concentration (while waiting for actual level):
      • Calculate Osm = (2 x Na) + (BUN/2.8) + (Glucose/18) + (Ethanol level/4.6)
      • Determine Osm Gap = (Measured Osm) - (Calculated Osm)
        • If Gap > 15 = abnormal
        • If Gap > 25 = very high à give empiric fomepizole (Antizol) if unsure of ingestion
      • Estimate Isopropanol Concentration (mg/dL) = 6.0  x Osm gap
    • General Notes:
      • Call or consult with Poison Center 1-800-222-1222
      • The half-life of the parent compound (isopropanol)
        • No Treatment = 3 hrs
    • GI Decontamination:
      • Generally avoided
      • Rarely helpful unless very early on (within 15-30 min) since alcohols are rapidly absorbed or co-ingestions and airway is protected
    • Proton Pump Inhibitor Therapy:
      • May theoretically help reduce the risk of hemorrhagic gastritis
    Clinical Considerations

    • There is no antidote as isopropanol does not get metabolized to a toxic acid.
    • Since isopropanol gets metabolized to acetone you might notice a fruity odor due to ketosis
    Related Content

    • South Med J 2009;102:867-69.
    • Am J Med 2006;119:e9.
    • Am J Kidney Dis 2002;40:e12.
    Editors & Reviewers

    Editors:  Anthony J. Busti, MD, PharmD, FNLA, FAHA

    Last Reviewed:  July 2015