Substance
- Methanol
- CH3OH
Common name or Trade
name
- 甲醇
- Used in 抗凍劑, 溶劑, 皮革工廠, 染料塗料
Involving system [1]
- Metabolic acidosis. lethargy
- GI system:
- Neurologic system: after poisoning 8
months to 2 years, secondary Parkinsonism.
- Eye: Retinopathy, blindness.
Presentation
[1]
- 6—12 hours, 18—24 hours even 60 hours.
After ingestion.
- Blurred vision.
- Stupor, coma.
- Headache
- SOB
- Nausea. Abdomen pain, diarrhea.
- High anion gap acidosis.
- High osmolar gap acidosis
Antidote and Treatment [2]
- Decontamination.
- Carbomix (activated charcoal) is
useless.
- Intubation while acute respiratory
failure.
- ACLS
- Ethanol: competition of aldehyde
dehydrogenase, 1 gm/kg BW= 紹興(18%) 6ml/ kg BW till seral ethanol
level 100—150 mg/dl. [1]
- Fomepizole: 10—20 mg/kg / day * 3—5
days. (inhibit metabolism of methanol). [1]
- Hemodialysis. [1]
- Folic acid: 50 mg IV every 4 - 6 hours until toxicity resolves (increase
formic acid oxidation into carbon dioxide and water). [3]. https://www.ebmconsult.com/articles/methanol-toxicology
- Leucovorin dose: 1 mg/kg (50-70 mg adults) IV
q4-6hr. (Folinic acid
or leucovorin, the biologically active forms of folic acid, must be used for
reversing toxicity due to dihydrofolate reductase inhibitors.)
Disposition
- Admit to ICU if severe acidosis, SOB,
respiratory failure, or acute kidney injury
- Consult ophthalmologist if there is
symptoms of eye.
REFERENCES
[1]. 急診醫學會, AILS 三版 p.255—265
[2]. Barceloux DG, Bond GR, Krenzelok
EP, Cooper H, Vale JA; American Academy of Clinical Toxicology Ad Hoc Committee
on the Treatment Guidelines for Methanol Poisoning. American Academy of
Clinical Toxicology practice guidelines on the treatment of methanol poisoning.
J Toxicol Clin Toxicol. 2002;40(4):415-46. doi: 10.1081/clt-120006745. PMID:
12216995.
[3]. Lim CS, Bryant SM. Forgoing the
Folate?-Contemporary Recommendations for Methanol Poisoning and Evidence
Review. Am J Ther. 2016 May-Jun;23(3):e850-4. doi:
10.1097/MJT.0000000000000059. PMID: 24531405.
edited by Yu-Jang Su Nov 28, 2020
