Isopropanol poisoning

Isopropanol ("rubbing alcohol", hand sanitiser, surgical spirit, windscreen de-icer) is metabolised to acetone (NOT formate or oxalate) — so produces ketosis WITHOUT a high anion-gap metabolic acidosis. CNS depression more severe and longer than ethanol (twice as potent, longer half-life). Features: intoxication, vomiting, abdominal pain, haemorrhagic gastritis, hypotension (peripheral vasodilation), coma, fruity ketotic breath, osmolar gap, ketonaemia/ketonuria, normal anion gap. ABCDE; bloods: VBG, U&E, glucose, paracetamol/salicylate, isopropanol level, ethanol level (rule-out), osmolality (measured), serum ketones, LFTs, lipase (haemorrhagic gastritis/pancreatitis). Clues: ↑ osmolar gap + ketosis WITHOUT acidosis → isopropanol. (Methanol/EG → ↑ osmolar gap WITH acidosis.)