2283 reported exposures in 2007 in the U.S. (Brent).
Poisonings with this agent are not mandatory to be reported.
Methanol is found in many household items – automotive supplies, and cleaning solvents.
Poisonings occur most often with ingestion of windshield-washer fluid.
Utilized in copying machines, canned heating products, embalming fluids, and paint removers.
Poisonings associated with “moonshine”.
Poisonings associated with metabolic acidosis.
Associated with visual changes that may lead to blindness, multiorgan system failure and death.
Untreated poisonings associated with a 28% death rate.
Visual problems or blindness occurs in 30% of survivors of methanol poisoning.
Major effects of ingestion results from its metabolism to formaldehyde, which is oxidized to formic acid.
When in ingested it is rapidly absorbed in the G.I. tract, so gastrointestinal decontamination with oral activated charcoal has minimal value.
Formic acid cause retinal and optic nerve damage in survivors of serious methanol poisonings.
Metabolism occurs in the liver and to some degree in the retina.
Metabolism occurs mainly through the hepatic enzyme alcohol dehydrogenase.
Ethanol is a competitive substrate for alcohol dehydrogenase and can be given to administered to inhibit metabolism of methanol, followed by dialysis to remove methanol and its metabolites.
Ethanol use for ethylene glycol or methanol poisoning can be associated with changes in mental status, hypoglycemia and pancreatitis.
Poisoned patients often require intubation and ventilation and fluid resuscitation.
The strongest predictive complications and death in methanol ingestion is the degree of acidosis, with a high mortality observed of the pH of less than 7.0.
Treatment with intravenous sodium bicarbonate is recommended when the pH is less than 7.3 and is continued until the pH is normal.
Further production of formic acid is prevented by inhibiting ADH with the administration of fomepizole.
Intoxication and severe academia may require the use of bicarbonate.
For intoxication utilizing ethanol therapy it is recommended to have adjunctive hemodialysis for serum concentrations of methanol of at least 50 mg per dL, the presence of significant acidosis or a visual signs or symptoms.