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Methanol and ethylene glycol poisoning: a case study and review of current literature

Published online by Cambridge University Press:  21 May 2015

William R. Henderson*
Affiliation:
Department of Emergency Medicine, Vancouver Hospital and Health Sciences Centre, Vancouver, BC
Jeffrey Brubacher
Affiliation:
Department of Emergency Medicine, Vancouver Hospital and Health Sciences Centre, Vancouver, BC
*
Department of Emergency Medicine, Vancouver Hospital and Health Sciences Centre, 855 W 12th Ave., Vancouver BC V5Z 1M9; fax 604 737-1959; [email protected]

Abstract

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Poisoning is an uncommon but potentially fatal outcome of toxic alcohol ingestion. The toxic alcohols methanol, ethylene glycol and isopropyl alcohol are commonly found in household and commercial products. Because the toxic effects are caused by the metabolites of methanol and ethylene glycol rather than the agents themselves, there is often a substantial delay between ingestion and onset of clinical toxicity. Anion and osmolar gaps are often used for the diagnosis and exclusion of these sometimes subtle overdoses. The pitfalls of using these tests to rule out alcohol ingestion are reviewed. Ethanol infusion is the traditional therapy for such overdoses. In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed.

Type
Toxicology • Toxicologie
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Goldfrank, LR, Flomenbaum, NE.Goldfrank’s toxicologic emergencies, 6th ed. Stamford (CT): Appleton & Lange; 1998. p. 104960.Google Scholar
2.Jacobsen, D, Hewlett, TP, Webb, R, Brown, ST, Ordinaro, AT, McMartin, KE.Ethylene glycol intoxication: evaluation of kinetics and crystalluria. Am J Med 1988;84:14552.CrossRefGoogle ScholarPubMed
3.McMartin, KE, Martin-Amat, G, Noker, PE, Tephly, TR.Lack of a role for formaldehyde in methanol poisoning in the monkey. Biochem Pharmacol 1979;28:6459.Google Scholar
4.McMartin, KE, Martin-Amat, G, Makar, AB, Tephly, TR.Methanol poisoning. V. Role of formate metabolism in the monkey. J Pharmacol Exp Ther 1977;201:56472.Google Scholar
5.Sharpe, JA, Hostovsky, M, Bilbao, JM, Rewcastle, NB.Methanol optic neuropathy: a histopathological study. Neurology 1982;32: 1093100.CrossRefGoogle ScholarPubMed
6.Aquilonius, SM, Bergstrom, K, Enoksson, P, Hedstrand, U, Lundberg, PO, Mostrom, U, et al. Cerebral computed tomography in methanol intoxication. J Comput Assist Tomogr 1980;4:4258.CrossRefGoogle ScholarPubMed
7.Hewlett, TPMcMartin, KE, Lauro, AJ, Ragan, FA.Ethylene glycol poisoning. The value of glycolic acid determinations for diagnosis and treatment. J Toxicol Clin Toxicol 1986;24:389402.CrossRefGoogle ScholarPubMed
8.Jacobsen, D, McMartin, KE.Antidotes for methanol and ethylene glycol poisoning. Clin Toxicol 1997;35:12743.Google Scholar
9.Winter, SD, Pearson, R, Gabow, PA, Schultz, AL, Lepoff, RB.The fall of the serum anion gap. Arch Intern Med 1990;150:3113.Google Scholar
10.McCoy, HG, Cipolle, RJ, Ehlers, SM, Sawchuk, RJ, Zaske, DE.Severe methanol poisoning: an application of a pharmacokinetic model for ethanol therapy and hemodialysis. Am J Med 1979;67:8047.CrossRefGoogle ScholarPubMed
11.Smithline, N, Gardner, KD Jr.Gaps: anionic and osmolal. JAMA 1976;236:15947.Google Scholar
12.Genari, FJ.Serum osmolality: uses and limitations. N Engl J Med 1984;310:1025.Google Scholar
13.Hoffman, RS, Smilkstein, MJ, Howland, MA, Goldfrank, LR.Osmol gaps revisited: normal values and limitations. J Toxicol Clin Toxicol 1993;31:8193.Google Scholar
14.Walker, JA, Schwartzbard, A, Krauss, EA, Sherman, RA, Eisinger, RP.The missing gap. A pitfall in the diagnosis of alcohol intoxication by osmometry. Arch Intern Med 1986;146:18434.CrossRefGoogle Scholar
15.Schelling, JR, Howard, RL, Winter, SD, Linas, SL.Increased osmolal gap in alcoholic ketosis and lactic acidosis. Ann Intern Med 1990;113:5802.CrossRefGoogle ScholarPubMed
16.Davidson, DF.Excess osmolal gap in diabetic ketoacidosis explained. Clin Chem 1992;38:7557.CrossRefGoogle ScholarPubMed
17.Glaser, DS.Utility of the serum osmolal gap in the diagnosis of methanol or ethylene glycol ingestion. Ann Emerg Med 1996;27:3436.Google Scholar
18.Ethanol for ethylene glycol poisoning [letter]. N Engl J Med 1981;304:9768.CrossRefGoogle Scholar
19.Catchings, TT, Beamer, WC, Lundy, L, Prough, DS.Adult respiratory distress syndrome secondary to ethylene glycol ingestion. Ann Emerg Med 1985;14:5946.CrossRefGoogle ScholarPubMed
20.Jacobsen, D, McMartin, KE.Methanol and ethylene glycol poisonings: mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol 1986;1:309.Google Scholar
21.Brent, J, McMartin, K, Phillips, S, Burkhart, KK, Donovan, JW, Wells, M, et al. Fomepizole for the treatment of ethylene glycol poisoning. N Engl J Med 1999;340:8328.CrossRefGoogle ScholarPubMed
22.Burns, MJ.Treatment of methanol poisoning with intravenous 4-methylpyrazole. Ann Emerg Med 1997;30:82932.CrossRefGoogle ScholarPubMed
23.Brent, J, McMartin, K, Phillips, S, Aaron, C, Kulig, K.Fomepizole for the treatment of methanol poisoning. N Engl J Med 2001; 344:4249.CrossRefGoogle ScholarPubMed
24.Jacobsen, D, Sebastian, CS, Barron, SK, Carriere, EW, McMartin, KE.Effects of 4-methylpyrazole, methanol/ethylene glycol antidote, in healthy humans. J Emerg Med 1990;8:45561.CrossRefGoogle ScholarPubMed
25.Keyvan-Larijarni, H, Tannenberg, AM.Methanol intoxication. Comparison of peritoneal dialysis and hemodialysis treatment. Arch Intern Med 1974;134:2936.Google Scholar
26.Gonda, A, Gault, H, Churchill, D, Hollomby, D.Hemodialysis for methanol intoxication. Am J Med 1978:64:74958.Google Scholar
27.Michelis, MF, Mitchell, B, Davis, BB.“Bicarbonate resistant” metabolic acidosis in association with ethylene glycol intoxication. Clin Toxicol 1976;9:5360.CrossRefGoogle ScholarPubMed
28.Birnbaumer, DM, Bessen, HA. Other alcohols. In: Rosen, P, Barkin, R, editors. Emergency medicine concepts and clinical practice, 4th ed. St Louis: CV Mosby; 1998. p. 252033.Google Scholar
29.From the NIH: Use of folate analogue in treatment of methyl alcohol toxic reactions is studied. JAMA 1979;242:1961–2.Google Scholar
30.Liu, JL, Daya, MR, Carrasquillo, O, Kales, SN.Prognostic factors in patients with methanol poisoning. Clin Toxicol 1998;36:17581.Google ScholarPubMed
31.Hantson, P, Lambermont, JY, Mahieu, P.Methanol poisoning during late pregnancy. Clin Toxicol 1997;35:18791.Google ScholarPubMed