Metabolic Acidosis Occurring during Paraldehyde Intoxication

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Abstract
A 35 year old man presented with nausea and vomiting, abdominal pain, confusion, and hyperpnea. He had consumed a large amount of paraldehyde during the previous few days. Laboratory studies revealed a profound metabolic acidosis. Intravenous alkalinizing therapy was begun but had to be curtailed because of relative oliguria. Peritoneal dialysis was performed and the acidosis was finally corrected. This is the fifth reported case of metabolic acidosis associated with paraldehyde intoxication. Data from this and from the previous cases are used in an attempt to elucidate the mechanism of the acidosis. Evidence is presented against the hypothesis that the acid is formed by paraldehyde breakdown prior to ingestion. Whether the drug produces acidosis by its own degradation or whether it does so by disturbing the intermediary metabolism of other substances, is not known. However, acetic acid, the major breakdown product of paraldehyde, was not the offending acid in the present case study.

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