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Megarbane B 1 , Borron SW 1 , Krencker E 2 , Hantson Ph 4 , Flesch F 2 , Jaeger A 3 , Baud FJ 1
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4-Methylpyrazole treatment in acute methanol intoxication | Title |
XX International Congress of the EAPCCT, Amsterdam, Netherlands, 2-5 May, 2000. In: J Toxicol Clin Toxicol 2000, 38(2), 218.
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| Methyl alcohol, Fomepizole, Antidotes, Therapy
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| Objective: Acute methanol poisoning may produce serious clinical events or even be lethal in cases of non-treatment or delayed treatment. Toxicity is due to the enzymatic metabolism of methanol by alcohol dehydrogenase that yields two toxic metabolites, formaldehyde and formic acid. Recognized treatment includes sodium bicarbonate, hemodialysis and ethanol therapy as a competitive inhibitor of methanol metabolism. 4-Methylpyrazole (4-MP) is now an established treatment for ethylene glycol poisoning. The aim of this study was to determine the efficacy and safety of 4-MP in methanol intoxication.
Methods: Retrospective data collection from patients (pts) hospitalized in ICU during 1992 1998 for methanol intoxication, confirmed by laboratory assessments and treated with 4-MP; descriptive analysis (me-dian
[range]) and report of 4-MP side effects.
Results: 11 pts were treated for documented methanol intoxication [cooking alcohol (7 pts), windshield washing fluid (1 pt), antifreeze (1 pt) and undetermined (2 pts)]: 7M/4F; 46 years [1858]; 5 pts with a past history of chronic alcoholism; 8 suicide attempts and 3 misuses. Six pts were severely and 5 mildly intoxicated. On admission, 6 pts were awake, 1 pt inebriated, 2 pts lethargic and 1 pt comatose requiring mechanical ventilation. Two pts presented bilateral blindness, 2 pts color vision disorder, 2 pts vomiting, 1 pt hypotension and 3 pts tachypnea. Serum methanol level on admission was 51 mg/dL [6518]. Six pts had co-ingested ethanol with blood concentrations of 14.5 mg/dL [035]. Arterial pH was 7.32 [7.107.51], serum bicarbonate 17.0 mmol/L [2.525.0], PaCO2 3.6 kPa [1.17.2], lactates 2.2 mmol/L [1.16.9] and creatinine 83 µmol/L [53128]. All pts were treated with 4-MP, 9 intravenously and 2 orally, with a loading dose of 700 mg [5001200], 2 [17] multiple doses and a cumulative dose of 1300 mg [5006000]. Hemodialysis was performed in the 2 pts who presented bilateral blindness. No patient died and all were alive without sequelae, except the 2 blind pts. Three patients received 5, 6 and 7 doses of 4-MP with respectively a total dose of 4000, 6000 and 3100 mg. The main adverse experiences with 4-MP were: nausea and headache in 1 pt, elevation of eosinophil cells, lymphangitis and burning sensation in 1 pt (the one who received 7 doses) and fever in 2 pts (of whom one received 5 doses).
Conclusion: 4-MP treatment was an effective and safe therapeutic antidote in preventing or diminishing methanol toxicity in 7 poisoned pts. Hemodialysis was only performed in case of ocular impairment on admission.
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| Conf. paper
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