Meeting the Needs of Neurodivergent Teens for Dialectical Behaviour Therapy: Challenges and Adaptation Strategies From Clinicians, Teens With Fetal Alcohol Spectrum Disorders and Caregivers.

Acetone is a volatile organic compound produced endogenously during ketone metabolism and exogenously through metabolism of isopropyl alcohol (IPA) [, ]. Clinically significant isopropanol or acetone exposure can cause central nervous system depression, ketonemia, ketonuria, and an elevated osmolar gap; when concomitant ketoacidosis is present, patients may also present with high anion-gap metabolic acidosis [, ]. Most reported cases of acetone toxicity are due to ingestion or inhalation. However, systemic toxicity from cutaneous exposure is rarely recognized, particularly in patients with impaired skin barriers or neurologic deficits. We describe a case of acetonemia in a quadriplegic patient after topical isopropyl alcohol was used to clean cranial connector sites, emphasizing the importance of considering transdermal absorption in the differential diagnosis of unexplained encephalopathy. A 48-year-old man with a complex medical history presented to the emergency department (ED) with acute worsening confusion and altered mental status. His history was significant for a C4 spinal cord injury with quadriplegia following a motor vehicle accident approximately two years earlier; enrollment in the ReHAB (Reconnecting the Hand and Arm to the Brain) clinical trial, involving implantation of eight left-sided cortical stimulation electrodes with intracranial leads and extracranial scalp connector sites for neuromodulation of right upper-extremity function; neurogenic bladder managed with a suprapubic catheter; prior deep vein thrombosis and pulmonary embolism on rivaroxaban; COVID-19-induced cardiomyopathy with recovery of ejection fraction to 60%; chronic hypotension with dysautonomia; ulcerative colitis; obstructive sleep apnea; and a stage IV sacral ulcer status post debridement three weeks before presentation, with prior cultures growing Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus.