SHM Converge Scientific Abstract ePoster Gallery-An Unforeseen Culprit: Cardiopulmonary Collapse Due to Toxic Air Freshener Ingestion

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An 88-year-old woman with dementia and hypertension presented with encephalopathy, rigors, new-onset atrial fibrillation with RVR, hypotension, lactic acidosis, hypothermia, and hypokalemia. She was treated in the ICU for presumed sepsis with fluids, broad-spectrum antibiotics, norepinephrine, potassium replacement, and external warming. Her arrhythmia, shock, metabolic abnormalities, and mental status improved, but no infectious source was identified on cultures or imaging.<br /><br />Further evaluation revealed constipation and possible fecal impaction. During an enema, nursing staff observed unusual stool containing paper, fabric, and bead-like material. Her daughter recognized these as missing air freshener beads from the home. Poison control felt the likely toxic agent was isopropyl alcohol, a component of the product. The patient had no known psychiatric history or prior toxic ingestions, and with supportive care she returned to baseline mental status and was discharged to a skilled nursing facility. Adult Protective Services was notified.<br /><br />The case highlights that in patients with unexplained encephalopathy and shock, toxic alcohol ingestion should remain on the differential. Isopropanol toxicity often causes rapid CNS depression and encephalopathy, with typical findings of ketosis without acidosis and an elevated osmolar gap. Severe poisoning can produce respiratory depression, vasodilation, decreased cardiac contractility, shock, and respiratory failure. Diagnosis may be supported by osmolar gap and toxin levels, and management is usually supportive; hemodialysis may be considered in severe cases, though evidence of benefit is limited.

Asset Subtitle

Colin MacKay

Meta Tag

Author List Colin MacKay, Colin Martyn, Jesse Doyle

Category Clinical Vignettes

Concept Toxic Alcohol Ingestion

Concept Isopropyl Alcohol

Concept Central Nervous System Depression

Concept Osmolar Gap

Concept Supportive Care

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine Internal Medicine Residency (Southwest)

Presenting Author Colin MacKay

Track Adult

Keywords

isopropanol toxicity

toxic alcohol ingestion

encephalopathy

septic shock mimic

atrial fibrillation with RVR

lactic acidosis

hypothermia

fecal impaction

osmolar gap

supportive care

Toxic Alcohol Ingestion

Isopropyl Alcohol

Central Nervous System Depression

Osmolar Gap

Supportive Care