Ethanol poisoning

MacEwen signs (MacEwen pupil) The pupil of a patient comatose from alcohol intoxication dilates briefly when the patient is stimulated but not awakened, while that of a patient comatose from structural disease does not  get dilated for mild stimulation.

Ref: Principles of forensic medicine, Apurva nandy, 3^rd Edition,Page 847.

Ans. 300-400 mg/dl

Ans. B

Competitive inhibitor of alcohol dehydrogenase [Ref Lehninger Principles of Biochemistry 4^th/e p. 336]

• Ethylene glycol poisoning should be suspected in an intoxicated patient with anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol concentration. 
• Oxidative reactions convert ethylene glycol to glycoaldehyde, and then to glycolic acid, which is the major cause of metabolic acidosis.
• The conversion of glycolic acid to glyoxylic acid proceeds slowly, further increasing the serum concentration of glycolic acid.
• Glyoxylic acid is eventually converted to oxalic acid and glycine. Oxalic acid does not contribute to the metabolic acidosis, but it is deposited as calcium oxalate crystals in many tissues.

The clinical syndrome of ethylene glycol intoxication has traditionally been divided into three stages:

• progressive involvement of the CNS, the cardiopulmonary systems, and the kidneys. However, presentation is highly variable and dependent on the amount ingested, the combined ingestion with ethanol, and the timing of medical intervention.