Benzyl Alcohol Intoxication

 

Substance

 

Benzyl Alcohol (C₇H₈O) - A preservative used in medications, cosmetics, and industrial applications. Metabolized in the liver to benzoic acid and hippuric acid, which are eliminated by the kidneys [1].

 

Common Name

Benzyl Alcohol

Found in solution in 注射劑的防腐劑， 照相顯影劑， 墨水、塗料、油漆、環氧樹脂塗料、染料、 明膠等的溶劑， 也用於製取香料和調味劑, 以作為肥皂、香水、化妝品和其他產品中的添加劑.

 

Involving System

Central Nervous System (CNS): Sedation, lethargy, coma, seizures  

Cardiovascular System: Hypotension [2], tachycardia, cardiac collapse Metabolic System: Metabolic acidosis (high anion gap)

Respiratory System: Respiratory depression, Respiratory depression [3].

Moderate poisoning: Severe drowsiness, hypotension, metabolic acidosis

- Severe poisoning: Coma, seizures, respiratory failure, cardiovascular collapse

 

Examination & Diagnosis

- Blood gas analysis: Metabolic acidosis with increased anion gap - Serum benzyl alcohol or benzoic acid levels (if available)

- Electrolytes, lactate, and kidney function tests

- ECG: Arrhythmia evaluation

- Chest X-ray: If respiratory complications are suspected

 

 

Presentation [4].

Mechanism & Metabolism (M)     

Overdose leads to CNS depression, metabolic acidosis, and respiratory failure due to toxic metabolites.

AMS: altered mental status

Acidosis: metabolic acidosis

Hypokalemia, hypophosphatemia

Hyperammonemia.

Neonates are particularly vulnerable due to immature liver metabolism.

 

Antidote

Decontamination & Initial Management

        - Activated charcoal is generally not recommended unless ingestion is recent and in large amounts

- Supportive care is key (IV fluids, oxygen therapy)

Pharmacological Treatment

- Sodium bicarbonate IV to correct metabolic acidosis

- Hemodialysis in severe cases with renal failure or refractory acidosis

- Symptomatic treatment: Vasopressors for hypotension, anticonvulsants for seizures

 

Disposition

Clinical Disposition & Follow-up   

- Mild cases: Observation for 6–12 hours with supportive care

- Moderate to severe cases: ICU admission for ventilatory support and hemodynamic monitoring

- Neonatal cases: Extreme caution, as even small amounts can cause fatal "gasping syndrome" due to toxic accumulation. [5].

Hemodialysis Indications: Severe metabolic acidosis, renal impairment, or refractory symptoms.

 

References

[1]. https://pubmed.ncbi.nlm.nih.gov/3229281/

[2]. https://pubmed.ncbi.nlm.nih.gov/2922508/

[3]. https://pubmed.ncbi.nlm.nih.gov/35787785/

[4]. https://pubmed.ncbi.nlm.nih.gov/35466010/

[5]. https://pubmed.ncbi.nlm.nih.gov/7133084/

 

 Edited by Yu-Jang Su  Feb 5, 2025