에탄올

해독제

에탄올(에틸 알코올)은 수의학에서 주로 **에틸렌 글리콜(부동액)** 또는 **메탄올** 중독의 **해독제**로 사용됩니다. - 현재는 **포메피졸(4-MP)**이 에틸렌 글리콜 중독의 우선적인 치료제이지만, 섭취 후 몇 시간 내에 내원한 경우 에탄올은 쉽게 구할 수 있고 경제적인 대안이 됩니다. - **기타 용도**: 95% 에탄올 경피 주사는 고양이 갑상선 기능 항진증 치료에 성공적으로 사용되었습니다. 또한 말에서 점액 운동 촉진제로 분무 형태로 사용되기도 합니다. > **임상 요점**: 의료용 에탄올을 구할 수 없는 응급 상황에서는 시판되는 증류주(보드카 등)를 수액에 혼합하여 생명을 구하는 치료에 사용하는 경우가 많습니다.

작용 기전: 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.

동물 종별 용량

Dogs

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.

Cats

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.

투여 경로

IVPOPercutaneousAerosol

금기

Concurrent use with fomepizole (usually contraindicated)

이상반응

CNS depression
Respiratory depression
Diuresis
Hypocalcemia
Metabolic acidosis
Pulmonary edema
Injection site pain and infection
Phlebitis
Extravasation injury
Bronchoconstriction and irritation (when aerosolized)

약물 상호작용

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

모니터링

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

과용량

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.

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