Isopropyl alcohol poisoning treated with hemodialysis: kinetics of isopropyl alcohol and acetone removal

A comatose and hypotensive patient was successfully treated with hemodialysis after ingesting 480 mL of isopropyl alcohol. Removal of isopropyl alcohol and its major metabolite acetone was measured in urine, blood, and dialysate. According to dialysate measurements, approximately 19 g of isopropyl alcohol and 7 g of acetone were removed per hour using a standard 1 m2 dialyzer. The average dialysance of isopropyl alcohol and acetone were 137 and 165 mL/min, respectively. Removal of isopropyl alcohol was 52 times and acetone 40 times more efficient through hemodialysis than through urinary excretion. Since coma and hypotension portend a bad prognosis and since urinary excretion is slow relative to hemodialysis removal, hemodialysis may be considered life-saving in patients comatose from isopropyl alcohol poisoning. There have been two previous reports of hemodialysis used for treatment of isopropyl alcohol intoxication [1, 2]. Neither of these reports describes the kinetics of isopropyl alcohol removal. This paper reports a third patient treated with hemodialysis who afforded us the opportunity to study blood, urine, and dialysate levels of isopropyl alcohol and its chief metabolite, acetone. By utilizing these results a comparison was made of urine excretion to dialysis removal of these compounds to compare their respective efficacy. In addition, the estimated removal by dialysance calculations was compared to estimated removal by measurement of dialysate volumes and concentrations.

Acetone metabolism during diabetic ketoacidosis

The presence and the importance of acetone and its metabolism in diabetic ketoacidosis has largely been ignored. Therefore, we studied acetone metabolism in nine diabetic patients in moderate to severe ketoacidosis. The concentration of acetone in plasma, urine, and breath, and the rates of acetone production and elimination in breath and urine were determined and the rates of vivo metabolism were calculated. Plasma acetone concentrations (1.55-8.91 mM) were directly related and were generally greater than acetoacetate concentrations (1.16-6.08 mM). The rates of acetone production ranged from 68 to 581 mumol/min/1.73 m2, indicating the heterogeneous nature of the patients studied. The average acetone production rate was 265 mumol/min/1.73 m2 and accounted for about 52% of the estimated acetoacetate production rate. Urinary excretion of acetone remained constant and accounted for about 7% of the acetone production rate in all patients. There was a positive linear relationship between the percentage of the acetone production rate accounted for by excretion in breath and the plasma acetone concentration. At low plasma acetone concentrations, approximately 20%, and at high plasma acetone concentrations, approximately 80% of the production rate was accounted for by breath acetone. In contrast, there was a negative linear relationship between the percentage of acetone production rate undergoing in vivo metabolism and plasma acetone concentration. At low plasma acetone concentrations, approximately 75%, and at high concentrations, approximately 20% of acetone production rate was accounted for by in vivo metabolism. Radioactivity from 2-[14C]-acetone was variably present in plasma acetone, glucose, lipids and proteins. No radioactivity was found in plasma acetoacetate, beta-hydroxy butyrate or free fatty acids or other anionic compounds. Exchange rates of acetone into other metabolites could not be estimated because of non-steady-state precursor product relationships in these patients.

Teenaged and pre-teenaged pregnancies: consequences of the fetal-maternal competition for nutrients

The study attempted to determine whether the growth needs of young mothers compete with the growth needs of their fetuses for available nutrients. In a large prospective study, 10- to 16-year-old mothers had significant smaller newborns at term than older mothers when the various maternal age groups were matched for prepregnancy body size and pregnancy weight gain. Five percent of the urines of 10- to 14-year-old mothers had 2+ or greater acetone vs only 2% of the urines of 17- to 32-year-old mothers (P less than .001). Acetonuria has been shown to be a marker for high perinatal mortality in undernourished gestations, and it correlated with a high perinatal mortality in the present study. The growth retardation found in the newborns of very young mothers disappeared during childhood.

Causes of the excessive rates of perinatal mortality and prematurity in pregnancies complicated by maternal urinary-tract infections

The study was undertaken to determine the causes of the more frequent pre-term deliveries, fetal and neonatal deaths associated with maternal urinary-tract infections during pregnancy. The combined perinatal mortality rate for eight common placental and fetal disorders was 42 per thousand births in the infected vs. 21 per thousand in the noninfected, owing to a greater mortality from noninfectious placental and fetal disorders in the gestations with the urinary-tract infections (P less than 0.001). All the mortality excess took place when the urinary-tract infections occurred within 15 days of delivery. Death rates were highest when the urinary-tract infections coexisted with maternal hypertension and acetonuria.Hydramnios, amniotic-fluid bacterial infections and abruptio placentae were responsible for two thirds of the more frequent preterm deliveries in the pregnancies complicated by urinary-tract infections.

Plasma acetone metabolism in the fasting human

The metabolism of acetone was studied in lean and obese humans during starvation ketosis. Acetone concentrations in plasma, urine, and breath; and rates of endogenous production, elimination in breath and urine, and in vivo metabolism were determined. There was a direct relationship between plasma acetone turnover (20-77 mumol/m(2) per min) and concentration (0.19-1.68 mM). Breath and urinary excretion of acetone accounted for a 2-30% of the endogenous production rate, and in vivo metabolism accounted for the remainder. Plasma acetone oxidation accounted for congruent with60% of the production rate in 3-d fasted subjects and about 25% of the production rate in 21-d fasted subjects. About 1-2% of the total CO(2) production was derived from plasma acetone oxidation and was not related to the plasma concentration or production rate. Radioactivity from [(14)C]acetone was not detected in plasma free fatty acids, acetoacetate, beta-hydroxybutyrate, or other anionic compounds, but was present in plasma glucose, lipids, and proteins. If glucose synthesis from acetone is possible in humans, this process could account for 11% of the glucose production rate and 59% of the acetone production rate in 21-d fasted subjects. During maximum acetonemia, acetone production from acetoacetate could account for 37% of the anticipated acetoacetate production, which implies that a significant fraction of the latter compound does not undergo immediate terminal oxidation.

[Pregnancy in diabetic patients. A calculated risk]

In general, a diabetic woman may count upon delivering a healthy child--provided optimal antenatal care. Success or failure of pregnancy will in the individual case decisively depend on the experience and efforts of the attending physician. The directives for the care of pregnant diabetic women as practiced at the II. Univ.-Frauenklinik München are demonstrated.

[Complications in null-diet]

Total starvation is effective for acute weight reduction in obesity. However, in 200 patients, most of whom also had internal diseases, 8% exhibited sometimes severe complications, i.e. reversible cerebral ischemia in 3 hypertensive patients when the blood pressure was lowered to the normal range by natriuresis of fasting; breakdown of water and electrolyte homeostasis with circulatory collapse, vomiting and vertigo; acute crises of paroxysmal nocturnal hemoglobinuria and porphyria respectively and increase of transaminases up to 200 mu/ml, or cardiac arrhythmias. Relative (?) contraindications for total fasting appear to be clinical sings of arteriosclerosis such as vascular bruits, angina pectoris and intermittent claudication. In case of doubt, the method should only be used in hospital.

Outcome at ages 1, 3, and 5 years of children born to diabetic women

A prospective study of infants born to women with diabetes mellitus is reported. The children were examined at birth and followed at 1, 3, and 5 years of age. Medical and psychological information was obtained through follow-up examinations. Intrauterine growth was atypical and there was an increase in neonatal problems and congenital malformations. There was an increased incidence of intellectual delay at 3 and 5 years of age. The presence of acetone in the urine during pregnancy had a significant, adverse effect on intellectual status of the offspring at 5 years of age. Birth weight was negatively related to intellectual status at both 3 and 5 years of age.

Kinetic urine creatinine determination with the Gemsaec analyzer

A rapid automated method for urinary creatinine with the Jaffé reaction is described. Interferences by protein, glucose and ketones are circumvented by the reaction rate kinetics. The precision and accuracy of this centrifugal method on the ENI-Gemsaec analyzer are comparable to the manual end-point Jaffé reaction with deproteinization and to the common Auto-Analyzer technique.

Serum IRI in insulin-treated diabetics during a 24-hour period

Serum immunoreactive insulin extracted with acid ethanol (total IRI) and blood glucose were measured in two groups of diabetics and a control group during 24-hour periods. One group of diabetics had received insulin for less than 1 month, and none had yet developed insulin antibodies. The other had been treated with insulin for 2 years or more. The average level of total IRI in the diabetics without antibodies was similar to that in the normals, but highly elevated in diabetics with antibodies, although the blood glucose levels were similar in the two diabetic groups. The increase in total IRI after the insulin injections was more rapid in patients receiving quick-acting insulin and most pronounced in those with the highest levels of total IRI. The total IRI peaked in the afternoon and dropped during the night. The short-term insulin-treated patients showed a better degree of diabetes control than those treated for 2 years or more. No correlation was found however, between the total IRI level and the degree of control in the latter group. The patients with the highest levels of total IRI had the highest frequency of hypoglycemic episodes. This is in agreement with the concept that the insulin antibodies may function as a circulating depot, which releases insulin irrespective of the metabolic need.

A patient with diabetes

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