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Methanol Toxicity Treatment & Management

  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
 
Updated: Mar 30, 2016
 

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.[8, 20, 21]

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
 
 
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, American Epilepsy Society

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Heart Association

Disclosure: Nothing to disclose.

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 Medical Association, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics; Eisai; Glaxo Smith Kline; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics; Lundbeck; Sepracor; Sunovion; UCB; Upsher-Smith.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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
  1. Jaff Z, McIntyre WF, Yazdan-Ashoori P, Baranchuk A. Impact of methanol intoxication on the human electrocardiogram. Cardiol J. 2014. 21(2):170-5. [Medline].

  2. Zakharov S, Kurcova I, Navratil T, Salek T, Komarc M, Pelclova D. Is the Measurement of Serum Formate Concentration Useful in the Diagnostics of Acute Methanol Poisoning? A Prospective Study of 38 Patients. Basic Clin Pharmacol Toxicol. 2014 Oct 11. [Medline].

  3. Finkelstein Y, Vardi J. Progressive parkinsonism in a young experimental physicist following long-term exposure to methanol. Neurotoxicology. 2002 Oct. 23(4-5):521-5. [Medline].

  4. Bitar ZI, Ashebu SD, Ahmed S. Methanol poisoning: diagnosis and management. A case report. Int J Clin Pract. 2004 Nov. 58(11):1042-4. [Medline].

  5. LeWitt PA, Martin SD. Dystonia and hypokinesis with putaminal necrosis after methanol intoxication. Clin Neuropharmacol. 1988 Apr. 11(2):161-7. [Medline].

  6. Gupta N, Sonambekar AA, Daksh SK, Tomar L. A rare presentation of methanol toxicity. Ann Indian Acad Neurol. 2013 Apr. 16(2):249-51. [Medline]. [Full Text].

  7. Coulter CV, Farquhar SE, McSherry CM, Isbister GK, Duffull SB. Methanol and ethylene glycol acute poisonings - predictors of mortality. Clin Toxicol (Phila). 2011 Dec. 49(10):900-6. [Medline].

  8. Rathi M, Sakhuja V, Jha V. Visual blurring and metabolic acidosis after ingestion of bootlegged alcohol. Hemodial Int. 2006 Jan. 10(1):8-14. [Medline].

  9. 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.

  10. Phang PT, Passerini L, Mielke B, et al. Brain hemorrhage associated with methanol poisoning. Crit Care Med. 1988 Feb. 16(2):137-40. [Medline].

  11. Jacobsen D, McMartin KE. Antidotes for methanol and ethylene glycol poisoning. J Toxicol Clin Toxicol. 1997. 35(2):127-43. [Medline].

  12. Rosenstock L, Cullen MR, eds. Textbook of Clinical Occupational and Environmental Medicine. Philadelphia, Pa: WB Saunders; 1994. 768.

  13. Hageman G, van der Hoek J, van Hout M, et al. Parkinsonism, pyramidal signs, polyneuropathy, and cognitive decline after long-term occupational solvent exposure. J Neurol. 1999 Mar. 246(3):198-206. [Medline].

  14. Chio A, Herrero Hernandez E, Mora G, et al. Motor neuron disease and optic neuropathy after acute exposure to a methanol-containing solvent mixture. Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Sep. 5(3):188-91. [Medline].

  15. Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings. Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol. 1986 Sep-Oct. 1(5):309-34. [Medline].

  16. Fujita M, Tsuruta R, Wakatsuki J, et al. Methanol intoxication: differential diagnosis from anion gap-increased acidosis. Intern Med. 2004 Aug. 43(8):750-4. [Medline].

  17. McKellar MJ, Hidajat RR, Elder MJ. Acute ocular methanol toxicity: clinical and electrophysiological features. Aust N Z J Ophthalmol. 1997 Aug. 25(3):225-30. [Medline].

  18. Blanco M, Casado R, Vazquez F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol. 2006 Feb. 27(2):452-4. [Medline].

  19. 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].

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

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

 
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