Q: Ethanol toxicity is usually get treated with supportive treatment. In life threatening situation hemodialysis is recommended. As a rule of thumb, at what blood level of ethanol toxicity - hemodylsis should be strongly considered?

Answer: 600 mg/dL

Standard management of ethanol toxicity is usually supportive with cardiovascular and pulmonary support. Monitoring of the electrolytes is essential. Also, special attention should be paid to prevention of hypothermia and hypoglycaemia.

Haemodialysis is reserved for life-threatening situations like severe metabolic acidosis,  arrhythmias, aspiration pneumonia, no response to conservative treatment and for levels above or 600mg/dl.

Elimination of ethanol is four times quicker than physiological elimination of ethanol as it is a small, water-soluble molecule which does not bind to proteins. Also, its volume of distribution is also limited.

Reference

Kraut J, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol 2008;3:208-25