Treatment of Methanol and Ethylene Glycol Poisoning
INTRODUCTION
Poisoning with methanol or ethylene glycol is potentially life-threatening, and prompt treatment is required to reduce the risk of permanent sequelae, such as renal dysfunction, visual disturbances, or death. The toxic effects of methanol and ethylene glycol result from their conversion to toxic metabolites: methanol is converted to formic acid, whereas ethylene glycol undergoes biotransformation to glycolic and oxalic acids. Conventional treatment of these poisonings has consisted primarily of IV administration of ethanol with or without hemodialysis. Ethanol has a higher affinity for alcohol dehydrogenase and inhibits the metabolism of methanol and ethylene glycol. Despite the widespread use of IV ethanol therapy for this indication over the past several decades, limited information has been published regarding the effectiveness and safety of this mode of treatment, other than in case reports and small case series.
More recently, the alcohol dehydrogenase inhibitor fomepizole has become available for the management of methanol or ethylene glycol poisoning. Fomepizole has been recommended as a preferred alternative to ethanol because of its higher affinity for alcohol dehydrogenase, its ease of administration and a lower requirement for monitoring. Recent publications have described the effectiveness of fomepizole for the management of methanol and ethylene glycol poisoning, but the clinical outcomes associated with ethanol administration in this setting have not been as well studied. Therefore, a retrospective study was undertaken to examine the administration and clinical effectiveness of ethanol for treatment of this potentially life-threatening event.
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