Surrogate alcohol poisoning is intoxication caused by the use of ethyl alcohol containing various impurities, or other monatomic and polyatomic alcohols. It usually occurs in patients suffering from alcoholism. Poisoning with alcohol surrogates can be accompanied by nausea, vomiting, diarrhea, hyperthermia, convulsions, loss of vision. Psychosis and acute renal failure may develop. There is a risk of death. The diagnosis is made on the basis of anamnesis, clinical manifestations and the results of special tests. Treatment – urgent detoxification, pharmacotherapy to restore the functions of the affected organs.
Surrogate alcohol poisoning – poisoning with true (containing ethanol) and false (containing other alcohols) alcohol surrogates. As a rule, it develops in patients with alcoholism. In addition, poisoning with alcohol surrogates may occur in adolescents who are unable to purchase high-quality alcohol or who do not pay enough attention to the quality of alcohol due to their own psychological immaturity. It is rarely diagnosed in healthy people who purchase counterfeit products in dubious outlets or who have received alcohol as a gift.
Surrogate alcohol poisoning occupies one of the leading positions in terms of prevalence among other poisonings. It poses a serious threat to the lives of patients. Some researchers claim that more than 90% of patients with surrogate alcohol poisoning die before hospitalization. The outcome of poisoning can be serious health problems. Surrogate alcohol poisoning is treated by specialists in the field of toxicology and narcology.
There are two groups of surrogates: true and false. True surrogates contain ethanol and various impurities. When using such drinks, poisoning occurs due to the toxic effect of impurities. False surrogates do not contain ethanol, but other alcohols that cause a state of intoxication. Poisoning develops as a result of the action of toxic metabolites formed during the splitting of alcohols.
Surrogate alcohol poisoning is usually diagnosed in alcoholics who are ready to consume any alcohol-containing liquids without taking into account their quality and health hazards. The most common causes of poisoning by true surrogates are the use of denaturation, varnish, alcohol stain for wood, alcohol-based medicines, alcohol-containing cosmetics, moonshine. Poisoning with alcohol surrogates that do not contain ethanol develops after taking methanol, as well as brake fluid and ethylene glycol-based de-icers.
The symptoms that occur after the use of true surrogates depend on the impurities that make up the alcohol-containing liquid. After taking hydrolysis alcohol, the manifestations are the same as after consuming too much of ordinary alcohol: nausea, vomiting, headache, dizziness, dry mouth. Hydrolysis alcohol is more toxic than ethyl alcohol, so signs of poisoning with alcohol surrogates are observed after taking less alcohol.
In patients with severe alcoholism, poisoning with alcohol surrogates often occurs when taking alcohol-containing cardiac medications. The composition of such drugs includes cardiac glycosides that provoke bradycardia. With systematic use or taking a large dose, acute heart failure may develop. Anesthetic is often added to external alcohol-containing products, which blocks the ability of the blood to deliver oxygen to organs and tissues. Poisoning with alcohol surrogates is manifested by symptoms of oxygen starvation. The mucous membranes become bluish, the blood turns brown.
The composition of cosmetics, along with ethanol, includes butyl and methyl alcohols. After taking such drugs, symptoms of ordinary acute alcohol poisoning occur in combination with signs of gastrointestinal tract damage. Possible inflammation of the gastric mucosa (gastritis) and the development of hepatitis. After drinking alcohol stain, as well as after taking external alcohol-containing drugs, poisoning with alcohol surrogates is manifested by cyanosis of the skin and mucous membranes, however, this symptom is not caused by oxygen starvation, but by the action of dyes that are part of the stain. The blue color persists for a long time (sometimes several months). When taking moonshine, there is a typical alcoholic intoxication, but moonshine has a more pronounced destructive effect on the liver due to the high content of fusel oils.
Symptoms based on other alcohols
The taste and smell of methyl alcohol are the same as that of ethyl alcohol. A fatal outcome can occur after consuming only 100 ml. Individual sensitivity varies, therefore, after consuming the same dose, one patient may experience more severe poisoning with alcohol surrogates than another. The severity of poisoning also depends on whether the patient simultaneously took ethanol, which is an antidote to methanol – some alcoholics dilute methyl alcohol with ethyl alcohol to avoid poisoning.
However, such attempts to save money involve an immediate risk to life. Methanol itself is not poisonous, but when it is broken down, strong poisons formaldehyde and formic acid are formed in the body. When using a large dose, signs of poisoning with alcohol surrogates appear almost instantly, death occurs in a few hours. When taking a small dose, there is a hidden period during which the patient feels satisfactory.
A mild form of surrogate alcohol poisoning is manifested by nausea, repeated vomiting, headache, dizziness, epigastric pain, blurred vision disorders – flickering of flies, impaired clarity of perception (“it is visible as through a fog”). The symptoms persist for several days, and then gradually disappear. When poisoning with alcohol surrogates of moderate severity, the manifestations are similar, but all the symptoms are more pronounced. After 1-2 days, the patient loses his sight. Subsequently, vision is partially restored, but then deteriorates again. Such poisoning usually does not pose a threat to life, but can lead to visual impairment with disability.
In severe form, there are pronounced typical symptoms of poisoning with alcohol surrogates, drowsiness and deafness. After a few hours, there is increasing thirst, pain in the legs, dryness and cyanosis of the mucous membranes, rhythm disturbances, tachycardia and increased blood pressure. Subsequently, tachycardia is replaced by bradycardia, blood pressure drops. Confusion of consciousness is observed, convulsions and psychomotor agitation are possible. In particularly severe poisoning with alcohol surrogates, the time interval between the appearance of the first symptoms and the occurrence of pronounced disorders of vital activity is only 2-3 hours. The result is coma and death as a result of respiratory arrest and cardiac disorders.
Another common poisoning occurs when using brake fluid containing ethylene glycol. The lethal dose, as with methanol poisoning, is only 100 ml. The cause of poisoning is the formation of toxic intermediate products of the breakdown of ethylene glycol, in particular oxalic acid, which provokes acidosis and has a destructive effect on the kidneys as a result of the formation of sodium oxalate crystals.
At first, poisoning with alcohol surrogates resembles a strong alcoholic intoxication. A few hours later, vomiting, diarrhea, abdominal pain, headache, severe thirst, tachycardia, shortness of breath and fever appear. The skin and mucous membranes are dry, there is redness of the skin and cyanosis of the mucous membranes. Psychomotor agitation is possible. In severe poisoning with alcohol surrogates, seizures, progressive disorders of consciousness and acute heart failure are observed. After 2-3 days, kidney failure develops, liver function disorders occur. The fatal outcome occurs due to the progression of renal failure.
Treatment begins with urgent gastric lavage and the introduction of sodium sulfate through a probe. In case of methanol poisoning, the patient is given ethanol (antidote) orally or a 2-5% alcohol solution is injected intravenously. In case of poisoning with substances containing ethylene glycol, a sodium bicarbonate solution administered orally or intravenously is used to eliminate acidosis. The tactics of further treatment in case of poisoning with true surrogates is determined by the revealed violations on the part of various organs and systems. All patients are given detoxification therapy, vitamins, nootropics, etc. are prescribed.
In case of poisoning with alcohol surrogates containing methanol, prednisolone, atropine, ATP and lumbar punctures are used to correct visual disturbances. When poisoning with ethylene glycol, the fight against kidney damage becomes a priority. Patients are prescribed diuretics, copious drinking and magnesium sulfate. Correction of the water-salt balance is carried out. In severe cases, hemodialysis or peritoneal dialysis is performed. The prognosis for poisoning with alcohol surrogates is determined by the type and amount of liquid taken. After the use of true surrogates, death rarely occurs, long-term consequences are possible as a result of damage to internal organs. As a result of taking substances containing methanol and ethylene glycol, a fatal outcome is often observed, many surviving patients become disabled.