Figure 1 www.trinitynewsdaily.com972 × 1161
Palcohol™ was recently approved by the Alcohol and Tobacco Tax and Trade Bureau for sale in the United States. It is a powder that is packaged in a 4x6 inch pouch, to which water can be added to produce an alcoholic beverage almost instantaneously. Proponents of its sale state that it provides a convenient medium for transportation of an alcoholic beverage (see link below). Potential recreational uses include camping, airline travel or any other activity where weight is a significant issue. Producers have attempted to prevent abuse of the product by keeping it dilute enough to make in impractical for use.
Believe it or not, it is rather simple to produce and instructions of how to make your own are readily available on the internet. The secret to powdered alcohol lies within the cyclodextrin molecule. Cyclodextrins (CDs) are cone like structures that have a hydrophobic center and a hydrophilic external surface. They are tasteless, odorless and poorly digestible. Parenteral administration of some CDs have caused renal toxicity, but this is not the case for oral administration . CDs are large, hydrophilic and are very poorly absorbed from the GI tract. Some CDs can be partially digested by amylase in the GI tract and passively absorbed, but these partially metabolized CDs are excreted in the urine. Oral CDs are similar to a non-digestable fiber.
Figure 2 www.chemiedidaktik.uni-wuppertal.de
Drug release from CDs is most commonly governed by diffusion control limits based on relative concentrations. CDs themselves whether absorbed orally or administered parenterally, do not readily cross biologic membranes and therefore have a low volume of distribution and are excreted via glomerular filtration. CDs administered parenterally are excreted unmetabolized. If the patient does not have any pre-existing renal insufficiency, all CDs will be excreted within 6-12 hours after administration.
The developers of powdered alcohol are not the first to discover these transport systems. They are already being used to administer hydrophobic drugs and make them more bioavailable. Alcohol is contained within the hydrophobic center of the cylcodextrin, which reconstitutes as a liquid alcohol when water is added to it.
The potential problems associated with development and distribution of such a product are innumerable – if for no other reason than this product makes alcohol more easily transportable and may be reconstituted with any liquid. Bath salts, essential oils, and any number of over the counter medications have reinforced the creativity and almost incessant desire of the human (usually adolescent) mind to destroy itself.
As of now, the makers of Palcohol state that it is very irritating making it less likely that abusers would snort it, however, the palatability of the powder alone is not known. Presently Palcohol comes in 2 pure form alcohols and four cocktail flavors. Undoubtedly, future development and production of powdered alcohol will focus on flavoring. As flavoring and marketing becomes more sophisticated, it is reasonable to assume that pediatric ingestions will become more commonplace. Clinicians, accordingly may need to check ethanol levels more frequently than they otherwise might as Palcohol becomes tastier and more accessible.
Powdered alcohol toxicity can be anticipated to have the same effects as any other commercial beverage containing ethanol. It is metabolized by the alcohol dehydrogenase enzyme located in the liver to acetylaldehyde and then further to acetic acid.
Acute alcohol toxicity manifests itself primarily as a CNS depressant presenting as altered mental status, or more severely as coma or death. An anion gap and Osmolar gap metabolic acidosis can be expected. Hypoglycemia, hypothermia, cardiac and liver toxicity should be anticipated. Treatment should be focused on supportive care, maintaining an open airway, and in chronic alcohol abusers- a banana bag (usually a mish-mash of thiamine, folate, B12, magnesium and others).
Take a look at the links below and judge for yourself:
1. Fenyvesi, E., M.A. Vikmon, and L. Szente, Cyclodextrins in Food Technology and Human Nutrition: Benefits and Limitations in 2012. Crit Rev Food Sci Nutr, 2015: p. 0.
2. Stella, V.J. and Q. He, Cyclodextrins. Toxicol Pathol, 2008. 36(1): p. 30-42.
This question prepared by: Mark Snider, DO Pediatric Emergency Medicine Fellow LeBonheur Children’s Hospital – Memphis, Tennessee
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Donna Seger, MD
Tennessee Poison Center
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