In severe isopropanol intoxication, which intervention may be required?

• A. Hemodialysis
• B. Gastric lavage
• C. Fomepizole
• D. IV diuretics

Answer: (A)

In severe isopropanol poisoning, removing the toxin quickly can be life-saving. Isopropanol is absorbed fast and is broken down to acetone, with the parent compound contributing to toxicity and an osmolar gap. In serious cases with very high blood levels or significant metabolic disturbance, hemodialysis can rapidly clear both isopropanol and acetone from the blood and correct the osmolar gap and any acidosis, which is why it may be required. Fomepizole blocks alcohol dehydrogenase and is used for methanol or ethylene glycol poisoning; it doesn’t improve isopropanol toxicity and can be unhelpful here. Gastric lavage is unlikely to help because alcohols are quickly absorbed, and intravenous diuretics do not effectively enhance toxin removal and may worsen dehydration. So, dialysis stands out as the intervention that may be required in severe cases.