A comparison of the bioavailabilities of oral and intravenous ethanol in healthy male volunteers

Simultaneous 15 N polarization of several biocompatible substrates in ethanol-water mixtures by signal amplification by reversible exchange (SABRE) method

Signal amplification by reversible exchange (SABRE) is a popular method for generating strong signal enhancements in nuclear magnetic resonance (NMR). In SABRE experiments, the source of polarization is provided by the nonthermal spin order of parahydrogen (pH₂ , the H₂ molecule in its nuclear singlet spin state). Polarization formation requires that both pH₂ and a substrate molecule bind to an Ir-based complex where polarization transfer occurs. Subsequently, the complex dissociates and free polarized substrate molecules are formed. In this work, we present approaches towards biocompatible SABRE, meaning that several small biomolecules are simultaneously polarized by using the SABRE method in water-ethanol solutions at room temperature. We are able to demonstrate significant ¹⁵ N-NMR signal enhancements in water-ethanol solutions for biomolecules like nicotinamide, metronidazole, adenosine-5'-monophosphate, and 4-methylimidazole and found that the first three substrates are polarized at the same level as a well-known pyridine. We show that simultaneous polarization of several molecules is indeed feasible when the reactions are carried out at an ultralow field of about 400-500 nT. The achieved enhancements are between 100-fold and 15,000-fold. The resulting ¹⁵ N polarization (maximal value about 4% achieved for metronidazole and pyridine at 45°C) strongly depends on the sample temperature, pH₂ bubbling pressure, and pH₂ flow. One more parameter, which is important for optimizing the enhancement, is the solvent pH. Hence, this study presents a step in developing biocompatible SABRE polarization and gives a clue on how such SABRE experiments should be optimized to achieve the highest NMR signal enhancement.

Methanol and ethylene glycol intoxication

Accidental or intentional ingestion of substances containing methanol and ethylene glycol can result in death, and some survivors are left with blindness, renal dysfunction, and chronic brain injury. However, even in large ingestions, a favorable outcome is possible if the patient arrives at the hospital early enough and the poisoning is identified and appropriately treated in a timely manner. This review covers the common circumstances of exposure, the involved toxic mechanisms, and the clinical manifestations, laboratory findings, and treatment of methanol and ethylene glycol intoxication.

Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management

In 2002, poison centers in the US reported 5816 human exposures to ethylene glycol. A guideline that effectively determines the threshold dose for emergency department referral and need for pre-hospital decontamination could potentially avoid unnecessary emergency department visits, reduce health care costs, optimize patient outcome, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the primary author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with a suspected exposure to ethylene glycol by (1) describing the process by which the exposure might be evaluated, (2) identifying the key decision elements in managing the case, (3) providing clear and practical recommendations that reflect the current state of knowledge, and (4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and health professionals providing care, considering all of the circumstances involved. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. (1) A patient with exposure due to suspected self-harm, misuse, or potentially malicious administration should be referred to an emergency department immediately regardless of the dose reported (Grade D). (2) Patients with inhalation exposures will not develop systemic toxicity and can be managed out-of-hospital if asymptomatic (Grade B). Patients with clinically significant mucous membrane irritation should be referred for evaluation (Grade D). (3) Decontamination of dermal exposures should include routine cleansing with mild soap and water. Removal of contact lenses and immediate irrigation with room temperature tap water is recommended for ocular exposures. All patients with symptoms of eye injury should be referred for an ophthalmologic exam (Grade D). (4) Patients with symptoms of ethylene glycol poisoning should be referred immediately for evaluation regardless of the reported dose (Grade C). (5) The absence of symptoms shortly after ingestion does not exclude a potentially toxic dose and should not be used as a triage criterion (Grade C). (6) Adults who ingest a "swallow" (10-30 mL), children who ingest more than a witnessed taste or lick, or if the amount is unknown of most ethylene glycol products should be referred immediately for evaluation. The potential toxic volume of dilute solutions (e.g., concentration <20%) is larger and can be estimated by a formula in the text (Grade C). (7) A witnessed taste or lick only by a child, or an adult who unintentionally drinks and then expectorates the product without swallowing, does not need referral (Grade C). (8) Referral is not needed if it has been >24 hours since a potentially toxic unintentional exposure, the patient has been asymptomatic, and no alcohol was co-ingested (Grade D). (9) Gastrointestinal decontamination with ipecac syrup, gastric lavage or activated charcoal is not recommended. Transportation to an emergency department should not be delayed for any decontamination procedures (Grade D). (10) Patients meeting referral criteria should be evaluated at a hospital emergency department rather than a clinic. A facility that can quickly obtain an ethylene glycol serum concentration and has alcohol or fomepizole therapy available is preferred. This referral should be guided by local poison center procedures and community resources (Grade D). (11) The administration of alcohol, fomepizole, thiamine, or pyridoxine is not recommended in the out-of-hospital setting (Grade D).

New developments in the therapy of intoxications

There has been a significant evolution in the clinical management of the poisoned patient over the last decade. Interventions that were once the cornerstone of treating the poisoned patient have become passé or have come under intense scrutiny. The advent of evidence-based medicine has forced clinical scientists to re-evaluate standard therapies. Gastrointestinal decontamination with either emesis or gastric lavage was the foundation of the initial management of most poisoned patients. Examination of the published literature demonstrated that neither emesis nor lavage changed the ultimate outcome of poisoned patients, and most poison centers have abandoned their use. Even the use of activated charcoal has been questioned. A multitude of studies demonstrated that the effectiveness of activated charcoal diminished significantly 30-60 min after the ingestion of a poison. No study has demonstrated that charcoal changed patient outcome. Cathartics have been deemed to be ineffective and potentially dangerous and are never indicated. Whole bowel irrigation should not be used routinely in the management of the poisoned patient. Multiple dose activated charcoal and urinary alkalinization, commonly used to enhance the elimination of some poisons, have limited usefulness. While these 'old' and more general methods of 'detoxification' have thus failed in most cases to improve or change patient outcome, the use of more specific antidotes, tailored to the exact cause of intoxication is to be considered. Very few antidotes, however, are used on a consistent basis in the management of poisoned victims. The indiscriminate use of antidotes may even be harmful to the patient and incur an inordinate expense. In addition to the commonly known antidotes N-acetylcysteine (acetaminophen, paracetamol), naloxone (opioids) and flumazenil (benzodiazepines), new antidotes include fomepizole to treat ethylene glycol and methanol poisoning and Crotalidae Polyvalent Immune Fab (Ovine) for pit viper envenomation.