Methanol intoxication causes severe metabolic acidosis and can lead to permanent visual damage or death. Methanol, readily available in common products like antifreeze, is ingested accidentally or deliberately as a substitute for ethanol and in suicide attempts. Because it may become a major fuel source in the 21st century and because industrial uses are expanding, deliberate and accidental intoxication is likely to increase. Rapid diagnosis is essential so that appropriate treatment can be instituted quickly. The authors review the pharmacology, clinical and laboratory findings, and pathology and pathophysiology of methanol intoxication. In addition, they discuss the differential diagnosis and treatment of acute intoxication, including the use of 4-methylpyrazole in preventing the conversion of methanol to formate. • INDEX TERMS: POISONING, METHYL ALCOHOL • CLEVE CLIN J MED 1990; 57:464-471 M ETHANOL (wood spirit, wood alcohol,Columbian spirit) ingestion causes a severe metabolic acidosis and visual disturbances that may become permanent despite aggressive therapy. In the past, the use of methanol in bootleg whiskey resulted in epidemic poisonings, and methanol continues to be ingested as a cheap substitute for ethanol. Methanol is also ingested in suicide attempts. It is readily obtained, and toxic amounts are present in a variety of compounds found in the home and workplace, including windshield washer fluid, antifreeze, carburetor fluid, duplicating fluid, paint remover, various solvents and cleaners, Sterno, and gasoline mixtures. If there is a move to methanol as a new automobile fuel, 1 its availability, and thus the incidence of acute From the Department of Pathology, The Cleveland Clinic Foundation.Address reprints requests to M.L.E.,