Episode 58: Toxic alcohols with Jerry Snow

Unexplained anion gap metabolic acidosis in critical care requires a systematic diagnostic approach to identify potential toxicological exposures. When common causes like ketoacidosis, lactic acidosis, and renal failure are excluded, toxic alcohols such as methanol and ethylene glycol become primary suspects. Dr. Jerry Snow, Director of the Medical Toxicology Fellowship Program, emphasizes that clinicians should prioritize early administration of Fomepazole to inhibit alcohol dehydrogenase, even before definitive lab results are available. While an increased osmolar gap supports a diagnosis of toxic alcohol ingestion, it should not be used to rule out the condition, especially in late-presenting patients. Hemodialysis remains a vital intervention for severe cases involving end-organ injury or refractory acidosis. Clinicians should maintain a low threshold for consulting regional poison centers, which provide essential expertise for managing complex, undifferentiated toxicological cases.