dehydrated alcohol (ethanol) injection

Adult Dosing .

Dosage forms:  INJ: 98%, 99%

septal myocardial ablation, obstructive hypertrophic cardiomyopathy patients

[1-3 mL/procedure (99%) intra-arterially divided in multiple sites]

Max: 5 mL/procedure; Info: inject in septal artery branches via percutaneous catheter; use lowest effective dose

methanol toxicity

[hemodialysis on, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 2.14 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 0.84 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis on, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 3.25 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 1.95 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

ethylene glycol toxicity (off-label)

[hemodialysis on, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 2.14 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 0.84 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis on, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 3.25 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 1.95 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

renal dosing

[septal ablation]

renal impairment: not defined

HD/PD: not defined

[methanol or ethylene glycol toxicity]

renal impairment: no adjustment

HD: no adjustment; no supplement after dialysis; PD: not defined

hepatic dosing

[septal ablation]

hepatic impairment: not defined

[methanol or ethylene glycol toxicity]

hepatic disease or impairment: start 7.6 mL/kg/dose (10%) x1, then 2.14 mL/kg/h (10%) if HD on; start 7.6 mL/kg/dose (10%) x1, then 0.84 mL/kg/h (10%) if HD paused

Peds Dosing .

Dosage forms:  INJ: 98%, 99%

methanol toxicity (off-label)

[hemodialysis on, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 2.14 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 0.84 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis on, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 3.25 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 1.95 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until methanol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

ethylene glycol toxicity (off-label)

[hemodialysis on, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 2.14 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, non-drinker or moderate drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 0.84 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis on, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 3.25 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

[hemodialysis paused, heavy drinker]

Dose: individualize dose; Start: 7.6 mL/kg/dose (10%) IV x1, then 1.95 mL/kg/h (10%) IV; Info: dilute 98% or 99% solution with D5W or NS to 10% concentration prior to use; adjust dose based on serum ethanol levels; continue until ethylene glycol level <20 mg/dL and patient asymptomatic with normal pH; refer to institutional protocol

renal dosing

[see below]

renal impairment: no adjustment

HD: no adjustment; no supplement after dialysis; PD: not defined

hepatic dosing

[see below]

hepatic disease or impairment: start 7.6 mL/kg/dose (10%) x1, then 2.14 mL/kg/h (10%) if HD on; start 7.6 mL/kg/dose (10%) x1, then 0.84 mL/kg/h (10%) if HD paused