What Is the Treatment of Methanol Poisoning?
Clinical Scenario
Methanol poisoning is a toxicological emergency. Urgent intervention is required to block the conversion of methanol to its toxic metabolites, reverse life-threatening metabolic acidosis, and prevent irreversible end-organ injury.
Treatment Approach
First-line management combines inhibition of methanol metabolism using an antidote with folinic acid supplementation and correction of metabolic acidosis, supported by general supportive care measures. The specific agents, dosing strategy, and decision algorithm are detailed in the full structured protocol.
Clinical Goals
Reduce serum methanol to below 20 mg/dL with the patient asymptomatic, and restore arterial pH to the normal range of 7.35–7.45.
References
DOI: 10.1081/clt-120006745
- If a patient presents with ophthalmological symptoms and signs or with significant acidosis in the context of a likely methanol ingestion, the initial priorities are to correct the acidosis with sodium bicarbonate, attempt to enhance metabolism of formate to CO₂ by administration of folinic acid, inhibit further metabolism of methanol to formate with either fomepizole or ethanol, and finally to arrange hemodialysis for further correction of metabolic abnormalities, if necessary.
- A pH below 7.3 should be treated with intravenous sodium bicarbonate solution to correct the acidosis to the normal range (7.35–7.45).
- Ethanol therapy should continue until the serum methanol concentration is <20 mg/dL (200 mg/L) and the patient is asymptomatic with a normal arterial pH.
- The suggested dose is 1 mg/kg/body weight, up to a total dose of 50 mg, administered intravenously, every 4–6 hours until methanol and formate have been eliminated.
- Although folinic acid is preferred to folic acid since it does not require metabolic reduction, folic acid is a suitable alternative if folinic acid is unavailable.
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