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Ethanol in Hospital FormulariesEthanol in Hospital Formularies

JAMA. 2003;289(18):2361-2361. doi:10.1001/jama.289.18.2361-a
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AUTHOR INFORMATION

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

ETHANOL IN HOSPITAL FORMULARIES

To the Editor: In their Research Letter, Dr Blondell and colleagues1 found that ethanol is still in the formularies of most US teaching hospitals. They suggest that ethanol is ineffective in treating alcohol withdrawal syndrome, and thus are concerned that having ethanol in a hospital formulary "may send the implicit message that alcohol is an appropriate remedy for illness."

In fact, recent practice guidelines cite ethanol as a treatment of methanol poisoning.2 Older guidelines recognize ethanol as the traditional (but little-studied) therapy for ethylene glycol poisoning,3 and there have been case reports describing successful use of ethanol in less common intoxications.4 5 Ethanol competitively inhibits the enzyme alcohol dehydrogenase from producing toxic metabolites of these various substances.

Another inhibitor of alcohol dehydrogenase, fomepizole, is available, but its use may be limited by hypersensitivity reactions.2 Thus, there are reasons to keep ethanol in hospital formularies for the foreseeable future.

References
Blondell RD, Dodds HN, Blondell MN.  et al.  Ethanol in formularies of US teaching hospitals.  JAMA.2003;289:552.
Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning.  J Toxicol Clin Toxicol.2002;40:415-446.
Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning.  J Toxicol Clin Toxicol.1999;37:537-560.
McKinney PE, Palmer RB, Blackwell W, Benson BE. Butoxyethanol ingestion with prolonged hyperchloremic metabolic acidosis treated with ethanol therapy.  J Toxicol Clin Toxicol.2000;38:787-793.
Vassiliadis J, Graudins A, Dowsett RP. Triethylene glycol poisoning treated with intravenous ethanol infusion.  J Toxicol Clin Toxicol.1999;37:773-776.

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Blondell RD, Dodds HN, Blondell MN.  et al.  Ethanol in formularies of US teaching hospitals.  JAMA.2003;289:552.
Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning.  J Toxicol Clin Toxicol.2002;40:415-446.
Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning.  J Toxicol Clin Toxicol.1999;37:537-560.
McKinney PE, Palmer RB, Blackwell W, Benson BE. Butoxyethanol ingestion with prolonged hyperchloremic metabolic acidosis treated with ethanol therapy.  J Toxicol Clin Toxicol.2000;38:787-793.
Vassiliadis J, Graudins A, Dowsett RP. Triethylene glycol poisoning treated with intravenous ethanol infusion.  J Toxicol Clin Toxicol.1999;37:773-776.
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