Version May 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| Clinical features |
| Early toxicity: CNS sedation and inebriation similar to ethanol intoxication |
| Late toxicity: metabolic acidosis with elevated anion gap; compensatory tachypnea/hyperpnea; coma in severe cases, accompanied by ocular toxicity (methanol) or renal failure (ethylene glycol) |
| Diagnostic testing |
| Arterial or venous blood gas (to determine extent of acidosis) |
| Basic chemistry (to determine anion gap and renal function) |
| Serum osmolality (to help determine diagnosis) |
| Serum ethanol concentration (to help determine osmolal gap) |
| Serum calcium concentration (to rule out ethylene-glycol associated hypocalcemia) |
| Serum methanol, ethylene glycol, and isopropanol concentrations (to establish diagnosis) |
| Urinalysis (for oxalate crystals) |
| Treatment |
| Secure airway as necessary in severely intoxicated patients |
| Treat hypotension with intravenous crystalloid, followed by standard vasopressors as necessary |
| Block alchohol dehydrogenase with fomepizole, 15 mg/kg IV loading dose, followed by 10 mg/kg q 12 h × 4 doses. If patient requires further treatment after this regimen, increase dose to 15 mg/kg every 12 hours |
| If fomepizole is unavailable or patient has a known allergy, block alcohol dehydrogenase with ethanol, 10 mL/kg of a 10% ethanol solution, followed by 1 mL/kg of 10% ethanol solution infused per hour. Titrate to serum ethanol concentration of 100 mg/dL. |
| Administer sodium bicarbonate, 1 to 2 meq/kg bolus followed by infusion of 132 meq NaHCO3 in 1 L D5W to run at 200 to 250 mL/hour for patients with pH below 7.3 |
| For patients with known or suspected methanol poisoning, administer folic acid, 50 mg IV every six hours |
| For patients with known or suspected ethylene glycol poisoning, administer thiamine, 100 mg IV, and administer pyridoxine, 50 mg IV |
| If the diagnosis is uncertain but clinical suspicion is high, the clinician should initiate antidotal treatment with alcohol dehydrogenase blockade and consultation for hemodialysis |
| Hemodialysis is indicated in severe toxicity, which we define as follows: |
| Metabolic acidosis, regardless of drug level |
| Elevated serum methanol or ethylene glycol levels (more than 50 mg/dL; or methanol 15.6 mmol/L, ethylene glycol 8.1 mmol/L), unless arterial pH is above 7.3 |
| Evidence of end-organ damage (eg, visual changes, renal failure) |
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