North Texas Research Forum 2024

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Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2024

Keywords

2-methyl-2-butanol, tert-amyl alcohol, intoxication

Disciplines

Internal Medicine | Medicine and Health Sciences

Abstract

2-methyl-2-butanol known as Tert-amyl alcohol (TAA) was previously used in the past for its hypnotic, anticonvulsant, and sedative properties.1 Both ethanol and 2M2B stimulate GABA-A receptors causing similar CNS effects.1 Animal studies have shown that toxicity is greater than 2-pentanol, 3-methyl-1-butanol, and ethanol1. 2M2B is replacing ethanol due to its low cost per dose, high potency, and does not produce a hangover as it is not metabolized to aldehydes.1 This case report describes the clinical course of a patient after intoxication with 2M2B and bringing awareness as it is difficult to confirm diagnosis since there are no specific clinical features and diagnostic labs that aid in diagnosing patient. A 41 year-old female with no significant past medical history was found altered on scene by EMS. Patient had ingested 2M2B prior to EMS arrival, was intubated and brought to the hospital where patient was admitted to the ICU with suspicion of intoxication. On EKG patient was noted to be in sinus rhythm. Levels of acetaminophen, salicylate, ethanol, isopropyl, and alcohol methyl were assessed, however, were normal. Urine drug screen was negative. Labs noted AKI with a creatinine of 1.36 - baseline was unknown. VBG noted metabolic acidosis (7.19/45.8/538/17.5). Lactic acid was normal. Although 2M2B has been known to cause increased osmolar gap and anion gap metabolic acidosis, patient’s labs were negative for these findings. Poison control was consulted; recommended observation and supportive care. She was treated with intravenous normal saline, thiamine 100 mg/day, and folate 1 mg/day. Repeat VBG noted improvement of acidosis (7.31/32.6/170/18.2). Propofol was discontinued to monitor neurological status. Symptoms of intoxication gradually resolved and patient was extubated on day two. Patient was not aware of the risk profile and had ingested 2M2B as a means of increasing sexual drive. Prior to discharge patient was educated regarding the hazards of 2M2B use. Resolution of cognitive status and motor functioning were observed and patient was discharged on the third day of hospital course. Diagnosis of intoxication in our patient was based on information by family members. It is difficult to confirm diagnosis as there are no specific clinical features. Although easily detectable via chromatography-mass spectrometry (GC-MS), it can be difficult to diagnose in the hospital setting as routine toxicology screens do not have the ability to detect it. As the use of 2M2B increases, it is imperative that we educate our patients regarding the risk profile.

Original Publisher

HCA Healthcare Graduate Medical Education

2-Methyl-2-Butanol (2M2B) Ingestion Related Toxicity

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