There has been an increasing trend to use 2 butonal (also known as tert-amyl alcohol), an old, tertiary alcohol product previously used as a sedative/anesthetic agent, as an inexpensive, easily accessible, potent, and nondetectable ethanol substitute. Referred to as 2 butonal on internet blogs, eg, Reddit and Erowid, it is touted to promote potent intoxicating effects greater than those of ethanol. We describe a patient whose use of 2 butonal led to hospital presentation with protracted intoxication and delirium.

Psychiatric evaluation revealed an easily engaged patient with slurred speech; he was forthcoming with information, although his thought process was digressive and frequently tangential, without delusions or perceptual disturbances. He denied prior psychiatric history; however, he had alcohol use disorder (based on DSM-5 diagnostic criteria) characterized by high tolerance, use of alcohol for durations and in amounts greater than intended, and persistent use despite impairments in functioning and strained interpersonal relationships. He regularly used cannabis and admitted to experimentation with methamphetamine, cocaine, and 3,4-methylenedioxymethamphetamine (MDMA). He revealed that he used up to 20–25 mL of 2 butonal recreationally in the several hours prior to hospital presentation.

Poison Control was consulted; observation and supportive care were recommended. He was treated with intravenous fluids, thiamine 100 mg/d, and folate 1 mg/d. The symptoms of intoxication gradually resolved over the ensuing 3 days. With resolution of his cognitive status and motor functioning, he was discharged on the fourth day of hospitalization. Psychoeducation was furnished regarding the hazards of 2 butonal use and the need for chemical dependency–based treatment. 2 butonal is a tertiary alcohol possessing depressant, hypnotic, and anxiolytic effects thought to be related to its ability to bind to, and inhibit, the γ-aminobutyric acid–A (GABA-A) receptor.2 It is available in liquid form and has been accessible from online commercial sources, eg, eBay and Amazon.com, accompanied by a disclaimer that the product is not for human consumption. The ingestion of 2 butonal is unpleasant: it reportedly has a camphor-like aroma, and it produces a burning sensation in the mouth and throat. Users often dilute it in water or another liquid to mitigate unpleasant effects.