A 53-year-old alcoholic presents with agitation, vomiting, and altered mental status. What substance are you concerned he may have ingested?

In the context of a 53-year-old alcoholic presenting with agitation, vomiting, and altered mental status, isopropyl alcohol is a substance of concern due to its specific effects on the body when ingested.

Isopropyl alcohol, commonly found in households as rubbing alcohol, is toxic when ingested. Symptoms of ingestion include CNS depression, dizziness, which can escalate to altered mental status. Additionally, nausea and vomiting are associated with its toxicity, aligning with the clinical presentation in this scenario. Given the context that the individual has a history of alcohol use, the likelihood of consuming isopropyl alcohol, whether intentionally or accidentally, increases.

While ethylene glycol, salicylates, and methanol also cause metabolic disturbances and can lead to similar symptoms, the distinct characteristics of isopropyl alcohol ingestion—like the combination of agitation and altered mental status—play a significant role in identifying the most likely substance in this case. Isopropyl alcohol is also metabolized differently than these other substances, leading to its own unique toxicological profile, which includes the symptoms observed in the patient.