Wednesday, October 10, 2007

Alcohol as a therapeutic?

From Australia (where else?) comes this gem of a story about alcohol being used therapeutically:

DOCTORS used a case of vodka to help save an Italian tourist being treated for poisoning in a Queensland hospital. And hospital authorities later proved very understanding about the booze bill. The 24-year-old man was brought to Mackay Base Hospital, in north Queensland, two months ago after he had ingested a large amount of the poisonous substance ethylene glycol, found in antifreeze, which can cause renal failure and is often fatal.

Well I got curious, of course, as to how exactly it was possible for alcohol to be GOOD for you (asides from red wine, but then its not the booze in red wine that's helping you, but some of the other stuff). I also got curious, however, because this story directly relates to the Chinese Poison Toothpaste Fiasco that has been leading headlines this year (you may recall, ethylene glycol is similar to glycerine and was substituted in toothpastes made in China).

Luckily, the beauty of the modern 'radiated library' known as the internet has merged with the 1980s/90s 'evidence-based medicine' movement to let average Joes like me access lots of free medical information. Here, you can find "Methanol and ethylene glycol poisoning: a case study and review of the literature" which neatly summarizes (in fairly penetratable medspeak) exactly what happens with ethylene glycol poisoning.

Essentially, ethylene glycol and alcohol go through the same metabolic pathways in the body, and thus are broken down by the same compounds. Ethylene glycol itself is not poisonous, it is its after-molecules that cause trouble. Oxalate acid in particular has a tendancy to build up in certain bodily tissues, especially the kidneys. This 'oxalate crystal deposition' is a primary mechanism of ethylene glycol's toxicity, and leads to kidney failure (and potentially death). This is ethylene glycol's metabolic pathway:

Treating ethylene glycol poisoning is really easy, you first have to block the molecule's metabolic pathways, to prevent further harm. This is usually accomplished with IV ethanol (alcohol) or fomepizole, and seeks to block the action of ADH in metabolizing the compound. Fomepizole simply inhibits the ability of ADH to do its work, while ethanol 'competes' with ethylene glycol for ADH floating around in your system. It turns out that booze is 100 TIMES more able to soak up ADH than ethylene glycol, so putting just a little bit of alcohol into your system quickly takes up all the available ADH, simply preventing ethylene glycol from breaking down while you are drunk. In the meantime, while ADH is being blocked, ethylene glycol is simply floating around, not dangerous, but not going away. Simple hemodialysis (filtering of the blood through an external machine) can accomplish the task of scrubbing your blood of the ethylene glycol.

This is why the docs gave the guy 3 drinks an hour for 3 days, because they essentially needed to keep him long-term buzzed , to prevent his kidneys from failing, while they scrubbed his blood. I guess he took so much, that it took them a while. HAH.

Also check out wikipedia.