The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

Abstract

Background: Methanol or ethylene glycol ingestion may result in significant morbidity or death without prompt treatment. Despite traditional and widespread use of intravenous ethanol as an antidote, its safety is not well described. An evaluation of the safety and ease of titrating ethanol infusions is necessary given the availability of an alternative antidote. Objective: To evaluate the safety and ease of titrating ethanol infusions for the treatment of methanol or ethylene glycol ingestion. Methods: We reviewed the hospital records of adults treated with ethanol at The Ottawa Hospital for methanol or ethylene glycol ingestion over a 9-year period. Using a standardized case report form, a single reviewer identified prespecified adverse events that developed after the start of ethanol therapy and classified dose adjustments during ethanol therapy as appropriate or inappropriate based on a priori criteria. Results: Forty-nine cases of methanol or ethylene glycol ingestion treated with ethanol were included in the analysis, of which 45 underwent hemodialysis, 38 were admitted to the intensive care unit, and 4 died. At least one adverse event was identified in 45 (92%) cases, including 35 (71%) with agitation requiring chemical or physical restraints and 10 (20%) with a depressed level of consciousness treated with intubation. The median number of ethanol concentration measurements per treatment course was 6 (range 0-24), of which only 27% were within the target range of 22 to 30 mmol/L and 47% were below. When measured concentrations were outside the target, the adjustment in ethanol dosing (or lack thereof) was deemed inappropriate 59% of the time, including 69% of the time during hemodialysis. Conclusion: Based on actual practice in a large academic centre, adverse events occur frequently with intravenous ethanol infusions, and ethanol titration is inefficient. The

Methanol poisoning as a new world challenge: A review

“…In one study, it was shown that complications of ethanol infusion in children were uncommon [ 121 ]. However, in another review of 49 adults treated with ethanol infusions, 92% of patients had at least one adverse event [ 122 ]. When intensive monitoring is unavailable, prescribing ethanol orally is also effective, especially when the patient is taken to hospital late.…”

Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS)

“…Adverse events and difficulty in maintaining therapeutic concentrations of ethanol have previously been reported in other studies. 8,9 Nevertheless, the outcome was generally favourable, irrespective of the antidote used, even in a subgroup of patients with more severe symptoms (PSS 2-3). Although some benefits were seen with fomepizole in a study involving dogs 10 , there have been no randomised controlled trials comparing fomepizole with ethanol in humans but a recent systematic review concluded that there are no significant differences in outcome.…”

Possible protective effect of ethanol on acute methanol intoxicated retina in rats: A histological and ultrastructural study

“…Though some authors ask for considering the safety profile and therapeutic drug monitoring when choosing ethanol as antidote for methanol [25] , many authors found ethanol administration effective and safe in management of patients with methanol poisoning [24] .…”