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Methanol and ethylene glycol poisoning

Marco L A Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
James F Winchester, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Methanol and ethylene glycol poisonings cause dozens of fatal intoxications in the United States (US) annually, and even relatively small ingestions of these alcohols can produce significant toxicity. Rapid recognition and early treatment, including alcohol dehydrogenase inhibition, are crucial. A summary table to facilitate emergent management is provided (table 1).

Methanol and ethylene glycol are frequently found in high concentration in automotive antifreeze and de-icing solutions, windshield wiper fluid, solvents, cleaners, fuels, and other industrial products. Most serious poisonings occur following ingestion; inhalation and dermal exposures rarely cause toxicity.

Patients may ingest toxic alcohols as an ethanol substitute, to inflict self-harm, or by accident, sometimes following transfer from the original container. Multiple victim methanol poisonings can occur with illicit distillation ("moonshine") or occult substitution for ethanol.

To provide proper management, clinicians must understand the metabolic activation of these alcohols to their toxic acid metabolites, the limitations of available laboratory tests, and the indications for treatment with antidotes, with or without hemodialysis.

The diagnosis and management of methanol and ethylene glycol intoxication will be reviewed here. Isopropyl alcohol intoxication and a general approach to the poisoned adult or child are discussed separately. (See "Isopropyl alcohol poisoning" and "General approach to drug poisoning in adults" and "Approach to the child with occult toxic exposure".)


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Literature review current through: Sep 2016. | This topic last updated: Sep 21, 2015.
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