Severe isopropanolemia without acetonemia or clinical manifestations of isopropanol intoxication.

This is the first reported case of severe isopropanolemia in a patient who did not experience associated clinical manifestations and acetonemia. The patient was found lying face down in a hotel lobby but at admission was alert and oriented to place and person. Toxicological analysis of the patient's serum revealed the presence of isopropanol at a concentration of 72 mmol/L. An increased serum osmolal gap (81 mOsm/kg) was also observed. The serum concentration of isopropanol decreased to 9.5 mmol/L 15.5 h after admission with an estimated half-life of elimination of 5-7 h. No serum acetone was detected throughout the patient's hospitalization. The identity of isopropanol was confirmed by gas chromatography/mass spectrometry. The patient remained awake and alert while in the hospital and was discharged 5 days after admission. These unusual findings raise some fundamental questions about the role of isopropanol conversion to acetone in the manifestation of symptoms usually associated with isopropanol intoxication.