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January 2012Volume 30, Issue 1, Pages 262.e3–262.e5
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Fomepizole for severe disulfiram-ethanol reactions☆☆☆

Margaret Sande
x
Margaret Sande
, MD, MS
,
David Thompson
x
David Thompson
, MD, MPH
Department of Emergency Medicine, Denver Health & Hospital Authority, Mail Code #0108, Denver, CO 80206, USA
Andrew A. Monte
x
Andrew A. Monte
, MD
Rocky Mountain Poison & Drug Center, Denver, CO, USA
Department of Emergency Medicine, University of Colorado Hospital Anschutz Medical Center, Aurora, CO, USA
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.014

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Figures

Fig. 1

Ethanol metabolism.

Fig. 2

Case 1: serum ethanol concentration vs time.

Ingestion of ethanol in the presence of disulfiram may cause a histamine-like reaction due to accumulation of acetaldehyde. These disulfiram-ethanol reactions (DERs) are manifested by hypotension, tachycardia, gastritis, and angioedema. Fomepizole, an inhibitor of alcohol dehydrogenase, may halt progression of this reaction by blocking ethanol metabolism to acetaldehyde. We present 2 cases of disulfiram and alcohol overdose leading to severe reactions unresponsive to fluid resuscitation and treated with a single dose of fomepizole.

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☆Financial support: None.

☆☆Presented at North American Congress of Clinical Toxicology Annual Meeting, Denver, CO, October 8, 2010 [Abstract].

© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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January 2012Volume 30, Issue 1, Pages 262.e3–262.e5