Methanol Toxicity Treatment & Management

  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Feb 3, 2012
 

Approach Considerations

Prompt medical care is key to avoiding complications secondary to methanol intoxication. Supportive therapy is aimed at initiating airway management, correcting electrolyte disturbances, and providing adequate hydration.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient’s system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH, but the enzyme’s affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.[5, 17, 18]

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30mL of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Consultations

Consultation with the following specialists can be beneficial:

  • Nephrologist - Consultation with a nephrologist is advisable to aid in the correction of the metabolic disturbance; the nephrologist can also help to arrange dialysis, respiratory care, or both
  • Ophthalmologist - Consultation with an ophthalmologist is recommended for assessment of ocular damage
  • Neurologist - Consultation with a neurologist is arranged to assist with the management of seizures in the acute setting or with the treatment of any subsequent movement disorders that may develop
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Kalyani Korabathina, MD  Consulting Physician, North County Neurology Associates, Inc

Kalyani Korabathina, MD is a member of the following medical societies: American Academy of Neurology and American Epilepsy Society

Disclosure: Nothing to disclose.

Coauthor(s)

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

David Likosky, MD  Director of Stroke Program, President of Medical Staff, Evergreen Hospital Medical Center

David Likosky, MD is a member of the following medical societies: American Academy of Neurology, American College of Physicians-American Society of Internal Medicine, and American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Jonathan S Rutchik, MD, MPH Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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  6. Casarett LJ, Doull J, Klaassen CD, eds. Casarett and Doull's Toxicology: The Basic Science of Poisons. 5th ed. New York, NY: McGraw-Hill; 1996:604-5, 756-7.

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  16. Hantson P, Duprez T, Mahieu P. Neurotoxicity to the basal ganglia shown by magnetic resonance imaging (MRI) following poisoning by methanol and other substances. J Toxicol Clin Toxicol. 1997;35(2):151-61. [Medline].

  17. LoVecchio F, Sawyers B, Thole D, et al. Outcomes following abuse of methanol-containing carburetor cleaners. Hum Exp Toxicol. Oct 2004;23(10):473-5. [Medline].

  18. Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol Poisoning: Ocular and Neurological Manifestations. Optom Vis Sci. Nov 28 2011;[Medline].

 
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