What is a key treatment for ethanol toxicity causing ketosis?

• A. Intravenous fluids with glucose
• B. Hemodialysis
• C. Fomepizole
• D. Activated charcoal

Answer: (A)

When ethanol is metabolized in the liver, it increases the NADH/NAD+ ratio. That shift suppresses gluconeogenesis and pushes the body toward ketone production, while hypoglycemia can develop because glucose formation is impaired. The most effective way to counter this is to give IV fluids containing glucose. The glucose provides an immediate energy source, raises insulin levels, and suppresses lipolysis, which reduces the production of ketones. In practice, this approach helps prevent and treat the ketosis that can accompany ethanol toxicity.

Fomepizole blocks alcohol dehydrogenase and is used for methanol or ethylene glycol poisoning, not ethanol toxicity, so it isn’t the right treatment here. Activated charcoal isn’t reliable for ethanol due to rapid absorption and poor binding. Dialysis can remove ethanol in very severe cases, but it’s not the routine or primary treatment for ethanol-induced ketosis.