Vujasinovic M, Kocar M, Kramer K, Bunc M, Brvar M
Department of Internal Medicine, Topolsica Hospital, Topolsica, Slovenia.
Hum Exp Toxicol. 2007 Dec;26(12):975-8. doi: 10.1177/0960327107087794.
1-Propanol and 2-propanol are isomers of an alcohol with three carbons. They are colorless liquids with a sweet odor. 1-Propanol is metabolized by alcohol dehydrogenase to propionic acid and presents with metabolic acidosis and elevated anion gap, whereas 2-propanol is metabolized by alcohol dehydrogenase to acetone and presents with rapidly developing (within 3-4 h after exposure) ketosis and ketonuria but without metabolic acidosis. We report a patient who simultaneously ingested a lethal dose of 1-propanol and 2-propanol as a hand disinfectant in hospital. The patient lost consciousness and stopped breathing within half an hour after ingestion. He was intubated and artificially ventilated. Initial laboratory results showed mixed acidosis with elevated anion gap, but ketonuria appeared only 12 h after admission and 6 h following the regaining of consciousness. Therefore, laboratory results in simultaneous poisoning with two isomers of alcohol are not just a sum of laboratory results obtained in isolated poisoning with each isomer because they influence each other's metabolism: 1-propanol retards the metabolism of 2-propanol to acetone. In conclusion, 1-propanol and 2-propanol poisoning presents early with mixed acidosis and elevated anion gap and only later with ketonuria.
1-丙醇和2-丙醇是含有三个碳原子的醇的同分异构体。它们是具有甜味的无色液体。1-丙醇经乙醇脱氢酶代谢为丙酸，并表现为代谢性酸中毒和阴离子间隙升高，而2-丙醇经乙醇脱氢酶代谢为丙酮，并表现为迅速发展的（接触后3-4小时内）酮症和酮尿症，但无代谢性酸中毒。我们报告一例患者在医院同时摄入致死剂量的作为手部消毒剂的1-丙醇和2-丙醇。患者在摄入后半小时内失去意识并停止呼吸。他接受了插管和人工通气。初始实验室结果显示伴有阴离子间隙升高的混合性酸中毒，但酮尿症仅在入院后12小时以及恢复意识后6小时出现。因此，同时中毒两种醇同分异构体时的实验室结果并非是每种同分异构体单独中毒时所获实验室结果的简单相加，因为它们相互影响彼此的代谢：1-丙醇会延缓2-丙醇代谢为丙酮。总之，1-丙醇和2-丙醇中毒早期表现为混合性酸中毒和阴离子间隙升高，后期才出现酮尿症。
