• Skip to content
  • Skip to primary sidebar
  • Skip to footer
  • Collections
  • ECG Library
  • Tox Library
  • CCC
  • PART ONE
  • CASES
  • Top 100

LITFL • Life in the Fast Lane Medical Blog

Emergency medicine and critical care medical education blog

Home | Critical Care Compendium | Methanol Toxicity

Methanol Toxicity

by Chris Nickson, Last updated January 15, 2013

OVERVIEW

  • industrial solvent and synthetic precursor
  • highly variable lethal dose
  • in itself if is not very toxic, however metabolised to formaldehyde -> formic acid (neurotoxic – retina and optic nerves)

CLINICAL FEATURES

  • drunk: windshield fluid, antifreeze, paint, paint removers, gasoline, adhesives, glass cleaner, a solvent/cleaner.
  • symptoms develop 12-24 hours post ingestion
  • neurology: cerebral oedema, seizures, meningeal irritation, cerebral infarction, blurred vision -> blindness, scotomata, papilloedema, loss of light reflexes
  • respiratory failure
  • circulatory shock
  • GI symptoms

INVESTIGATIONS

  • raised osmolar gap
  • severe metabolic acidosis (raised anion gap)
  • methanol level (not useful acutely due to availability and turn around times)
  • normal ionized Ca2+

MANAGEMENT

  • decreased production of toxic metabolites:

-> ethanol (competitive inhibitor to alcohol dehydrogenase)
-> 4-methylapyrazole (same as ethanol but easier to titrate and no sedative effects)
-> sodium bicarbonate (undissociated formic acid more toxic than the dissociated product – give if pH < 7.3)
-> folinic acid: 50mg Q4hrly (decreases formate levels and decreases toxicity)

  • increase elimination:

-> haemodialysis: effectively and rapidly removed including toxic metabolites

Share this:

  • Facebook
  • LinkedIn
  • Twitter

About Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | + Chris Nickson | RAGE | INTENSIVE| SMACC

Reader Interactions

Leave a comment... Cancel reply

Primary Sidebar

Tox LibraryECG Library LITFLultrasound libraryMedical Eponym Library EponymictionaryTrauma LibraryTropical Library

Footer

All LITFL posts by EMAIL or RSS

LITFL Weekly review by EMAIL or RSS

Research and Reviews by EMAIL or RSS

Frivolous Friday Five by EMAIL or RSS

Feed service provided by by FeedPress

Blog • About • Disclaimer • Contact

#FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Based on a work at https://lifeinthefastlane.com

Copyright © 2007 - 2018 · Powered by vocortex and iSimulate