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Toxic Alcohol Poisoning — Methanol Emergency

Acute methanol poisoning with metabolic acidosis, blindness and toxic alcohol antidote therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Toxic Alcohol Poisoning — Methanol Emergency?

Methanol (wood alcohol) is a toxic alcohol commonly ingested in counterfeit or improperly distilled beverages and industrial products; it is metabolised by alcohol dehydrogenase to formaldehyde and then to formic acid, producing severe metabolic acidosis and selective optic nerve and putaminal injury.

After a latent period of 12-24 hours, patients develop nausea, abdominal pain, headache, blurred vision (snowfield vision), seizures, coma and severe high-anion-gap metabolic acidosis with markedly raised osmolar gap; mortality is high without prompt antidote and dialysis.

Treatment consists of immediate fomepizole (15 mg/kg load then 10 mg/kg every 12 h) or ethanol infusion to inhibit alcohol dehydrogenase, sodium bicarbonate to correct acidosis, folinic/folic acid to enhance formate metabolism and urgent haemodialysis to remove methanol and formate, with ICU support for shock and respiratory failure.

Symptoms

Latent period 12-24 hours after ingestion
Nausea, vomiting and abdominal pain
Visual loss and snowfield vision
Severe headache and confusion
Tachypnoea (Kussmaul) due to acidosis
Seizures and coma
Putaminal infarction on CT in severe cases

Risk Factors

Counterfeit alcoholic beverages
Industrial or solvent worker exposure
Suicidal ingestion
Mass methanol outbreak
Alcohol use disorder
Adolescent experimentation
Substandard distilled spirits

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suspected methanol ingestion within 24 h
  • Visual loss after alcohol intake
  • Severe acidosis with raised anion or osmolar gap
  • Confusion or coma after ingestion

Treatment Methods

01
ABC, IV access and arterial blood gas
02
Sodium bicarbonate to correct acidosis
03
Fomepizole 15 mg/kg load (or ethanol infusion)
04
Folinic/folic acid 50 mg every 4 h
05
Urgent haemodialysis for severe acidosis or visual loss
06
ICU monitoring for shock and respiratory failure
07
Notification of poison centre and forensic investigation

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.