Methanol and ethylene glycol poisoning
- Marco L A Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
Marco L A Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
- Professor of Emergency Medicine Biomedical & Molecular Sciences
- Queen's University, Kingston Canada
- James F Winchester, MD
James F Winchester, MD
- Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
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. Methanol poisoning outbreaks with hundreds of victims are rare, but continue to occur around the globe, overwhelming available critical care and hemodialysis infrastructure [1,2].
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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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES OF OVERDOSE
- Physical examination
- Differential diagnosis
- Laboratory evaluation
- - Basic testing
- - Additional tests with toxic alcohol exposure
- Pitfalls in laboratory testing
- - Testing for methanol and ethylene glycol
- - Lactate
- - Urine testing
- - Plasma osmolal gap
- Overview of emergent management
- Airway, breathing, circulation
- Gastrointestinal decontamination
- Treatment with sodium bicarbonate
- Alcohol dehydrogenase inhibition
- - Approach and initiation
- - Fomepizole
- - Ethanol
- Cofactor therapy
- Preterminal care
- PEDIATRIC CONSIDERATIONS
- Younger children
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS