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Ethanol

By: Dr. Nicholas Dodman

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Overview

  • Ethanol, a monohydric alcohol, is a central nervous depressant. It is also a rich source of calories.
  • Like other alcohols, ethanol is metabolized by the liver under the influence of an enzyme, alcohol dehydrogenase.
  • Medically, ethanol is administered IV to treat ethylene glycol toxicity. In this situation, it acts as a competitive inhibitor of alcohol dehydrogenase, slowing the metabolism of ethylene glycol to toxic metabolites (such as glycoaldehyde, glycolate, glycoxalate, and oxalic acid).
  • Ethanol can also be used to treat methanol poisoning (similar rationale).
  • In addition, it can serve as a source of calories in a TPN regimen.

    Brand Names and Other Names

  • This drug is registered for use in humans only.
  • Human formulations: Alcohol and dextrose in water (generic)
  • Veterinary formulations: None

    Uses of Ethanol

  • Treatment of ethylene glycol toxicity
  • Increasing caloric intake and replenishing fluids.

    Precautions and Side Effects

  • While generally safe and effective when prescribed by a veterinarian, ethanol can cause side effects in some animals.
  • Ethanol should not be used in animals with known hypersensitivity or allergy to the drug.
  • Ethanol should not be given simultaneously with blood as pseudo agglutination or hemolysis may occur.
  • Ethanol in D5W should not be infused at such a rate as to cause sedation. If sedation or disorientation occurs, the infusion rate should be slowed.
  • Ethanol should be used with caution in diabetic patients if hypoglycemia is to be avoided (see below).
  • When administered for a sustained period as an energy source, ethanol can lead to vitamin B deficiency. If given at too fast a rate of infusion ethanol may cause over hydration with resultant pulmonary edema.
  • Ethanol should only be given IV and care should be taken to avoid perivascular injection.
  • It inhibits ADH release and causes diuresis though if infused too rapidly overhydration may occur.
  • Fluid and electrolyte status should be monitored during ethanol infusion.

    Drug Interactions

  • CNS depressants, like barbiturates and phenothiazines, increase the sedative effects of alcohol.
  • Cephalosporins, chlorpropamide, disulfiram, furazolidone, metronidazole, and procarbazine cause a disulfiram-like reaction, including signs of weakness, tachycardia, and vomiting.
  • The pharmacologic effects of antidiabetic agents, including insulin, may be increased by alcohol resulting in hypoglycemia.
  • Alcohol may potentiate aspirin-induced intestinal blood loss and may increase side effects caused by bromocriptine.

    How Ethanol is Supplied

  • 5% alcohol in 5% dextrose in water [1000 mL]
  • 10% alcohol in 5% dextrose in water [1000 mL]
  • There are other non-pharmacological grade alcohols available in a variety of concentrations

    Dosing Information

  • Medication should never be administered without first consulting your veterinarian.
  • For ethylene glyocol toxicity, ethanol is generally given intravenous as small boluses or as a constant rate infusion for 2 to 3 days duration.

    Dogs – the protocols for use vary and may include:
  • 22 mL/kg of 5% solution intravenously every 4 hours for 24h; then every 6 hours for a further 24 hours
  • Loading dose of 0.6 to 0.8 ml/kg orally or by intravenous injection of a 20% solution followed by 1.7 ml/kg/hour of a 7% solution for 48 hours
  • 5.5 ml/kg IV every 4 hours for 24 hours of 20% solution or as constant rate infusiojn at 1.4 ml/kg per hour

    Cats – the protocols for use vary and may include:
  • 5 mL/kg/h of a 5% solution (by intravenous constant rate infusion)
  • 1.35 ml/kg/hour of a 20% solution for 60 hours
  • 5.5 ml/kg IV every 4 hours for 24 hours of 20% solution or as constant rate infusion at 1.25 ml/kg per hour for 72 hours

  • The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, the entire treatment plan should be completed to prevent relapse.



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