# ETOH and hyperventilation



## mycrofft (May 21, 2011)

Had a debate once.
GIVEN: moderately drunk pt, hyperventilating, otherwise essentially normal hx and assessment.
1. Does the effect of ETOH intox (not hangover) make you more prone to experience the metabolic effects of hyperventilating?
2. Doesn't hypervent make you "blow off" ETOH (and CO2) faster and so lessen the potential metabolic interaction?


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## usafmedic45 (May 21, 2011)

> Doesn't hypervent make you "blow off" ETOH (and CO2) faster and so lessen the potential metabolic interaction?



The actual amount of ETOH exhaled is incredibly small.  Most is excreted through the kidneys.



> Does the effect of ETOH intox (not hangover) make you more prone to experience the metabolic effects of hyperventilating?



Not from any hard and fast objective measure I have seen, but it could conceivably intensify the subjective findings.


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## mycrofft (May 21, 2011)

*A coworker insisted those were correct.*

I said alcohol will not alkalize you significantly and leave you still breathing, and in a hangover it isn't the pH that bothers you but the metabolic byproducts and alcohol's congeners.

BUT the majority of "emergent" hypervents we saw were also drunk and not at home. Maybe a psychosocial thing?


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## usafmedic45 (May 21, 2011)

> A coworker insisted those were correct



Your coworker is a troglodytic moron.



> I said alcohol will not alkalize you significantly and leave you still breathing



Actually, ethanol is a common cause of anion gap _acidosis_.  



> BUT the majority of "emergent" hypervents we saw were also drunk and not at home. Maybe a psychosocial thing?



Most likely.  



> in a hangover it isn't the pH that bothers you but the metabolic byproducts and alcohol's congeners.



If you've drank enough alcohol to cause a derangement of the pH in an otherwise healthy person, you'll likely have bigger problems than a normal hangover.


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## mycrofft (May 21, 2011)

*Like type 2 diabetes*

Or a diet consisting of bar counter food.
I"ll start with the Fritos, then a side of pickled eggs, followed by pig's feet and a nice malt liquor, please. And chicharones for dessert, make sure they're fresh. (hey, Mac, pas the nuts and popcorn will ya?)


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## CAOX3 (May 21, 2011)

usafmedic45 said:


> The actual amount of ETOH exhaled is incredibly small.  Most is excreted through the kidneys.



Good old oxidation, lets see if I remember correctly.  The kidneys breakdown alcohol through oxidation into acetldhyde (spelling?) then to acetic acid and the remnants are blown off through CO2, urine and saliva.

Maybe, its been a while.

.


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## mycrofft (May 22, 2011)

*Acetaldehyde, yep.*

HOw about formaldahyde?


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## usafmedic45 (May 22, 2011)

> HOw about formaldahyde



Do you mean what happens if you ingest it?


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## mycrofft (May 22, 2011)

*No, as an end stage byproduct of ETOH metabolism*

and yes I realized to late, "formaldehyde".
Probably not, probably acetaldehyde.


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## usafmedic45 (May 22, 2011)

I've never heard of it being a significant byproduct in organismal metabolism.  It doesn't show up in significant enough levels in most people to show up on the autopsy of someone who has not been embalmed.


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## mycrofft (May 22, 2011)

*Or drank the Phillipine beer circa 1968*

Knew a guy who would drink isopropyl (probably protected by the ETOH already on board), wonder what his UA would show.


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## usafmedic45 (May 23, 2011)

> probably protected by the ETOH already on board



You're thinking of ethylene glycol (antifreeze). 



> wonder what his UA would show



Probably nothing out of the ordinary unless you ran it through a GC or GC/MS.


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## mycrofft (May 26, 2011)

*Nope, Isopropyl alcohol.*

I guess he could have had something else in the Iso bottle, but it wasn't colored. It rendered him sick and unconscious, but  it ought to have killed him.
Like drinking "squeeze" (methyl alcohol), only reason you survive that is you're already full of ETOH.
In Nebraska, the e-glycol would protect you from *freezing*.After you died.


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## samiam (May 30, 2011)

mycrofft said:


> I guess he could have had something else in the Iso bottle, but it wasn't colored. It rendered him sick and unconscious, but  it ought to have killed him.
> Like drinking "squeeze" (methyl alcohol), only reason you survive that is you're already full of ETOH.
> In Nebraska, the e-glycol would protect you from *freezing*.After you died.



Isopropanol which is commonly used in rubbing alcohol gets metabolized (oxidized) into acetone and usually only causes CNS depression in the form of coma, lethargy and ataxia, not acidosis like methanol. This would be consistent with your patients symptoms.  Interestingly if you ingest acetone it gets reduced thru metabolism and turned in to isopropanol. Unfortunately I cannot cite the biological process behind the metabolism since this info came from my Orgo Chem experience.

Cannot think of any reason the ethanol (booze) would mask/protect him of anyone with more bio knowledge wants to chime in. 

Etheylene Glycol is harmless in in itself but is eventually metabolized into glycolic acid and calcium oxalate crystals. The glycolic acid can cause acidosis and the calcium oxalate crystals can build up in the renal pathways and the brain causing a whole host of issues. I believe it also presents with CNS depression symptoms similar to ethanol intoxication. The treatment for etheylene glycol posining is interestingly ethanol is one of the treatments for this because it slows the metabolic breakdown of the ethylene gylcol into bad stuff. There is also a newer drug called Fomepizole which as I have just read is apparently more effective at reducing renal damage. I am not sure of the action that formepizole takes to stop the process.


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