In severe isopropanol intoxication, which therapy is indicated?

• A. Intravenous fluids
• B. Gastric lavage
• C. Hemodialysis
• D. Fomepizole

Answer: (C)

The key idea is that removing the toxin quickly is crucial in severe isopropanol poisoning. Isopropanol is small and dialyzable, so hemodialysis rapidly lowers its blood level and helps reverse the osmolar gap created by the toxin. This makes dialysis the most effective intervention when the intoxication is severe, especially if the patient has significant CNS depression or instability.

Fomepizole blocks alcohol dehydrogenase and would prevent formation of the metabolite acetone, but the toxic entity here is the isopropanol itself; inhibiting its metabolism would keep more isopropanol in the body and worsen toxicity, so it isn’t indicated. Intravenous fluids provide supportive care but do not promptly remove the toxin, and gastric lavage is unlikely to help because isopropanol is rapidly absorbed and lavage is rarely beneficial in modern practice.

So, in severe cases, hemodialysis is the therapy that most effectively and rapidly clears the toxin.