In any patient with coma and an unexplained osmolal gap (the difference between calculated and observed osmolarity), a toxic alcohol should be strongly considered Ingestion of ethanol in young children can lead to hypoglycemia, hypothermia, and coma Isopropyl alcohol toxicity classically presents as intoxication with ketosis, but without metabolic acidosis Methanol and ethylene glycol ingestion can lead to severe metabolic acidosis and should be treated with fomepizole, an alcohol dehydrogenase inhibitor that prevents the metabolism to their toxic metabolites In severe cases, hemodialysis is also indicated The alcohols and glycols are some of the most commonly available organic compounds Ethanol is best known as the psychoactive ingredient in beer, wine, and liquor; it is also a commonly encountered solvent and is used as a topical antiseptic, chemical intermediate, and in some instances, a rubbing alcohol Methanol, or methyl alcohol, functions as an antifreeze (in windshield washers/deicers and gasoline antifreeze) and as a solvent in many industrial and home products Isopropyl alcohol serves as a rubefacient Ethylene glycol is used primarily as a deicer or antifreeze A related class of compounds, the glycol ethers, is widely used in rug shampoos and brake fluids The toxicity of these glycol ethers is complex and beyond the scope of this discussion Ethanol The most commonly ingested alcohol is ethanol After ingesting ethanol, children may develop nausea, vomiting, stupor, and ataxia Coma and death from apnea may occur if significant quantities are consumed In adolescents, blood concentrations of less than 50 mg/dL rarely result in overt sensory or motor impairment Values of 80 to 150 mg/dL are consistent with intoxication and cause mild neurologic findings Lethal blood alcohol concentrations are generally higher than 500 mg/dL Infants and toddlers who ingest ethanol have a clinical course that is significantly different from that in adolescents and adults; a triad of coma, hypothermia, and hypoglycemia appears once ethanol levels exceed 50 to 100 mg/dL This triad may be accompanied by metabolic acidosis Ethanol decreases physical coordination, and increases risk taking behavior, so consider the possibility of head trauma in patients with coma after ethanol intoxication