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Review
. 2010 Aug 24:2:67-75.
doi: 10.2147/OAEM.S5346. eCollection 2010.

Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole

Bruno Mégarbane  1
Affiliations
Review

Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole

Bruno Mégarbane. Open Access Emerg Med. .

Abstract

Ethylene glycol (EG) and methanol are responsible for life-threatening poisonings. Fomepizole, a potent alcohol dehydrogenase (ADH) inhibitor, is an efficient and safe antidote that prevents or reduces toxic EG and methanol metabolism. Although no study has compared its efficacy with ethanol, fomepizole is recommended as a first-line antidote. Treatment should be started as soon as possible, based on history and initial findings including anion gap metabolic acidosis, while awaiting measurement of alcohol concentration. Administration is easy (15 mg/kg-loading dose, either intravenously or orally, independent of alcohol concentration, followed by intermittent 10 mg/kg-doses every 12 hours until alcohol concentrations are <30 mg/dL). There is no need to monitor fomepizole concentrations. Administered early, fomepizole prevents EG-related renal failure and methanol-related visual and neurological injuries. When administered prior to the onset of significant acidosis or organ injury, fomepizole may obviate the need for hemodialysis. When dialysis is indicated, 1 mg/kg/h-continuous infusion should be provided to compensate for its elimination. Side-effects are rarely serious and with a lower occurrence than ethanol. Fomepizole is contraindicated in case of allergy to pyrazoles. It is both efficacious and safe in the pediatric population, but is not recommended during pregnancy. In conclusion, fomepizole is an effective and safe first-line antidote for EG and methanol intoxications.

Keywords: ethanol; hemodialysis; metabolic acidosis.

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Figures

Figure 1
Figure 1
Mechanism of methanol and ethylene glycol toxicity. Symptoms are related to the toxic metabolites resulting from successive oxidations by alcohol (ADH) and aldehyde (AldDH) dehydrogenases. The primary site of metabolism is the liver although some methanol metabolism may occur within the retina.
Figure 2
Figure 2
Algorithm for treatment of EG and methanol poisoned patients.
See this image and copyright information in PMC

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