Hemodialysis for Methanol Intoxication

Tobin, Morris; Lianos, Elias A.

doi:10.3109/08860227909064915

Journal of Dialysis

1979

DOI: 10.3109/08860227909064915

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Hemodialysis for Methanol Intoxication

Morris Tobin

Elias A. Lianos

Abstract: A patient with toxic levels of methanol was hemodialyzed while receiving an ethanol infusion. It was demonstrated that during the dialysis significant quantities of both ethanol (17.70 gms) and methanol (26.69 gms) were extracted. Also, it was shown that the ethanol did not competetively inhibit the extraction of the methanol. Since ethanol is removed in significant quantities during dialysis, one should increase its infusion rate during hemodialysis and decrease the rate when the patient is not being dialyzed… Show more

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Cited by 7 publications

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Prolonged Hemodialysis in Methanol Intoxication

Burgess

1992

Pharmacotherapy

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Methanol poisoning may be treated conservatively by inducing a diuresis and administering ethanol to halt the metabolism of methanol to more toxic metabolites. In severe intoxications, hemodialysis may be necessary to remove the toxins and limit the metabolic disturbances. The duration of dialysis needed to achieve this is unclear. A case report of a severe methanol poisoning is reported which required 21 hours of hemodialysis to bring the serum methanol levels down to a nontoxic level.

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Prolonged Hemodialysis in Methanol Intoxication

Burgess

1992

Pharmacotherapy

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Methanol poisoning

Kruse

1992

Intensive Care Med

163

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Methanol ingestion is an uncommon form of poisoning that can cause severe metabolic disturbances, blindness, permanent neurologic dysfunction and death. While methanol itself may be harmless, it is converted in vivo to the highly toxic formic acid. The diagnosis is sometimes elusive and requires a high index of suspicion. Because antidotal treatment is available it is important to recognize methanol poisoning promptly. The presence of metabolic acidosis associated with an increased anion gap and increased osmol gap are important laboratory findings. Specific therapeutic measures include correction of the metabolic acidosis with sodium bicarbonate and administration of enteral or parenteral ethanol to competitively inhibit the metabolic breakdown of methanol to formic acid. Hemodialysis accelerates the elimination of both methanol and formic acid and also assists in correction of the metabolic acidosis. Experimental data suggests that administration of folic acid may be of benefit by hastening the metabolism of formic acid to carbon dioxide. Prompt institution of specific therapy can probably decrease the morbidity and mortality associated with this form of poisoning.

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Methanol poisoning

Becker

1983

The Journal of Emergency Medicine

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Methanol poisoning is an uncommon but an extremely hazardous intoxication. Since methanol is a versatile fuel and is having increasing usage in an energy-conscious society, a high index of suspicion and swift laboratory confirmation is essential in managing this poisoning. Methanol poisoning may occur in sporadic or epidemic circumstances. Chronic exposure may occur in the occupational setting. Man is uniquely susceptible to methanol toxicity, perhaps dependent upon folate metabolism. Classic symptoms of methanol toxicity can only occur in laboratory animals who are rendered folate deficient. Folate may be useful in humans enhancing removal of the toxic products of methanol poisoning. The enzyme responsible for metabolism of methanol is alcohol dehydrogenase. Ethanol has a higher affinity for this enzyme and is preferentially metabolized. Simultaneous ethanol and methanol administration may confuse the onset of the intoxication. Pyrazoles may also be used to inhibit alcohol dehydrogenase thus preventing the intoxication. The most important initial symptom of methanol poisoning is visual disturbance. The symptoms may be delayed up to 24 hours after ingestion due to simultaneous alcohol administration and metabolic processes. Laboratory evidence of severe metabolic acidosis with increased anion and osmolar gaps strongly suggest the clinical diagnosis. There may be an important association between mean corpuscular volume which is significantly higher in cases of severe methanol poisoning than in mild cases.(ABSTRACT TRUNCATED AT 250 WORDS)

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Hemodialysis for Methanol Intoxication

Cited by 7 publications

References 6 publications

Prolonged Hemodialysis in Methanol Intoxication

Prolonged Hemodialysis in Methanol Intoxication

Methanol poisoning

Methanol poisoning

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