Toxic Alcohol Poisoning: Emergency Department Recognition and Management in Patients With Complex Health and Housing Needs.

The found down inebriated patient is a frequent presentation in the emergency department. Although standard ethanol intoxication may be the primary clinical suspicion, a critical subset of these cases involves ingestion of a toxic alcohol-specifically, methanol, ethylene glycol, or isopropyl alcohol. These high-risk ingestions are disproportionately prevalent among patient populations facing severe social inequities, including those experiencing housing instability and behavioral health crises. In these groups, toxic alcohols are sometimes used as ethanol substitutes or for intentional self-harm. Late presentations to the emergency department are common among these populations, drastically increasing the likelihood of poor outcomes. These patients present a profound diagnostic and therapeutic challenge. Consequently, emergency nurses must maintain a high clinical suspicion to ensure prompt diagnosis, resuscitation, and targeted therapies, including antidotes. Emergency nurses serve as an important safeguard against assuming ethanol intoxication in at-risk populations. This paper equips them to identify and advocate for alternative diagnoses beyond routine ethanol ingestion. This article also delineates the patient care pathway-encompassing clinical presentation, diagnostic strategies, emergency department management, and psychosocial support-for these underserved patients from triage to admission.