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Pathophys and Cause ⬇

Pathophys:Converted by alcohol dehydrogenase to formic acid, which causes brain and optic nerve toxicity and acidosis

Lab and Xray ⬆ ⬇

Lab:Methanol level >20 mg %; high osmolar gap (see ethylene glycol above), r/o ethylene glycol and/or alcohol ingestion

Treatment ⬆

Rx:

  • Alcohol dehydrogenase inhibition w: ethanol iv, or fomepizole (Antizol) (Nejm 2009;360:2216; 2001;344:424) 15 mg/kg iv over 30 min, then 10 mg/kg q12h × 4 doses, then 15 mg/kg q12h until livel <20 mg %; usually takes 4 doses
  • Bicarb and supportive rx
  • Folate 1 mg/kg iv q4h × 6
  • Hemodialysis for large ingestions, levels >50 mg %, acidosis (pH <7.1), sx