What is the hallmark metabolic finding in isopropyl alcohol ingestion?

What is the hallmark metabolic finding in isopropyl alcohol ingestion?

• A. Ketosis with acidosis
• B. Ketosis without acidosis
• C. Lactic acidosis
• D. Hyperglycemia

Answer: (B)

When isopropanol is ingested, it is quickly converted to acetone, a ketone body that accumulates in the body. The hallmark metabolic finding is ketosis without acidosis because acetone is not an acid and does not drive a metabolic acidosis. Lab-wise you often see an elevated osmolar gap due to the parent compound and acetone, but the acid-base status remains with a normal bicarbonate and normal pH (normal anion gap). This contrasts with substances like methanol or ethylene glycol, which cause metabolic acidosis, or with lactic acidosis, which involves elevated lactate. Hyperglycemia isn’t a characteristic feature here. The clinical picture may include CNS depression and a fruity acetone odor, but the defining metabolic clue is ketosis without acidosis.

When isopropanol is ingested, it is quickly converted to acetone, a ketone body that accumulates in the body. The hallmark metabolic finding is ketosis without acidosis because acetone is not an acid and does not drive a metabolic acidosis. Lab-wise you often see an elevated osmolar gap due to the parent compound and acetone, but the acid-base status remains with a normal bicarbonate and normal pH (normal anion gap). This contrasts with substances like methanol or ethylene glycol, which cause metabolic acidosis, or with lactic acidosis, which involves elevated lactate. Hyperglycemia isn’t a characteristic feature here. The clinical picture may include CNS depression and a fruity acetone odor, but the defining metabolic clue is ketosis without acidosis.