エタノール
エタノール（エチルアルコール）は、獣医学において主に**エチレングリコール（不凍液）**または**メタノール**中毒の**解毒剤**として使用されます。 - 現在は**ホメピゾール（4-MP）**がエチレングリコール中毒の第一選択薬ですが、摂取後数時間以内に来院した場合、エタノールは入手しやすく経済的な代替薬となります。 - **その他の用途**: 95%エタノールの経皮注射は猫の甲状腺機能亢進症の治療に成功しています。また、馬の粘液動態改善薬として噴霧吸入されることもあります。 > **臨床のポイント**: 医療用エタノールが入手できない緊急時には、市販の蒸留酒（ウォッカや穀物アルコールなど）を静脈内輸液に混合して救命治療に使用することがよくあります。
作用機序: Ethanol acts by **competitively inhibiting the enzyme alcohol dehydrogenase**. - Ethylene glycol/Methanol + **Alcohol dehydrogenase** → Toxic metabolites (glycoaldehyde, glycolate, glyoxalate, and oxalic acid). - By occupying the enzyme, ethanol prevents this conversion, allowing the parent toxin (ethylene glycol or methanol) to be excreted primarily unchanged in the urine. - **Note**: For alcohol to be effective, it must be given very early after ingestion; it is seldom useful if started 8 hours after a significant ingestion.
動物種別の用量
- Ethylene glycol poisoning · 5.5 mL/kg IV q4h for 5 treatments, then q6h for four additional treatments · IV · q4h then q6h · 9 treatments total · As a 20% solution; dosed as a CRI over 1 hour
- Ethylene glycol poisoning · 8.6 mL/kg slowly IV followed by a CRI of 1.43 mL/kg/hr · IV · CRI · at least 36 hours although 48 hours is probably better · Make a 7% ethanol solution. If EG test was positive initially, check before stopping treatment; discontinue if it reverts to negative.
- Ethylene glycol toxicity · 5.5 ml of 20% ethanol solution/kg · IV · q4h for 5 treatments, then q6h for 4 additional treatments · 9 treatments total · Adjust dose to maintain blood ethanol levels above 35 mg/dl.
- Ethylene glycol toxicity (CRI method) · Loading dose of 1.3 ml/kg of 30% solution, then 0.42 mg/kg/h · IV · CRI · 48 hours · Constant rate infusion method.
- Ethylene glycol toxicity (mild cases) · As directed (equivalent to IV dosing) · PO · As directed · Until toxicity resolves · For clinically mild cases with minimal CNS signs; vodka is often used.
- Ethylene glycol poisoning · 5 mL/kg IV q6h for 5 treatments, then q8h for four additional treatments · IV · q6h then q8h · 9 treatments total · As a 20% solution; dosed as a CRI over 1 hour
- Ethylene glycol poisoning · 8.6 mL/kg slowly IV followed by a CRI of 1.43 mL/kg/hr · IV · CRI · at least 36 hours although 48 hours is probably better · Make a 7% ethanol solution. If EG test was positive initially, check before stopping treatment; discontinue if it reverts to negative.
- Ethylene glycol toxicity · 5 ml of 20% ethanol solution/kg · IV · q6h for 5 treatments, then q8h for 4 additional treatments · 9 treatments total · Fomepizole is generally preferred over ethanol in cats if available.
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Concurrent use with fomepizole (usually contraindicated)
有害事象
- CNS depression
- Respiratory depression
- Diuresis
- Hypocalcemia
- Metabolic acidosis
- Pulmonary edema
- Injection site pain and infection
- Phlebitis
- Extravasation injury
- Bronchoconstriction and irritation (when aerosolized)
薬物相互作用
- Bromocriptine · Alcohol may increase the severity of side effects seen with bromocriptine
- Activated Charcoal · Will inhibit absorption of orally administered ethanol; do not use if administering ethanol orally
- CNS Depressant Drugs (barbiturates, benzodiazepines, phenothiazines) · Alcohol may cause additive CNS depression
- Fomepizole (4-MP) · Inhibits alcohol dehydrogenase; ethanol metabolism is reduced significantly and alcohol poisoning (CNS depression, coma, death) can occur. Use together is generally not recommended.
- Insulin and antidiabetic drugs · Alcohol may affect glucose metabolism and the actions of insulin or oral antidiabetic agents
- Chlorpropamide, furazolidone, metronidazole · A disulfiram reaction (increased acetaldehyde with tachycardia, vomiting, weakness) may occur
- Fomepizole · Increases risk of severe alcohol toxicity; concurrent use should be avoided. · major
モニタリング
- Alcohol blood levels (maintain at 100 to 130 mg/dL; safer to maintain >130 mg/dL than to fall below 100 mg/dL)
- Ethylene glycol or methanol levels
- Degree of CNS effect
- Fluid and electrolyte status
過量投与
If clinical signs of overdosage occur (**lateral nystagmus, respiratory depression, profound obtundation**), either slow the infusion or discontinue temporarily. Alcohol blood levels may be used to monitor both efficacy and toxicity of alcohol.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。