What is methanol toxicity?

Updated: Nov 05, 2018
  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Methanol, also known as wood alcohol, is a commonly used organic solvent that, because of its toxicity, can cause metabolic acidosis, neurologic sequelae, and even death, when ingested. It is a constituent of many commercially available industrial solvents and of poorly adulterated alcoholic beverages. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes. (See Etiology and Pathophysiology and Presentation.) [1]

Sophisticated imaging techniques have enabled a better understanding of the clinical manifestations of methanol intoxication. Additionally, neurologic complications are recognized more frequently. This is possible because of early recognition of the toxicity and because of advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements. (See Workup, Treatment, and Medication.)

According to a study by Jaff et al, methanol intoxication can lead to several ECG changes, with sinus tachycardia and non-specific T-wave changes being the most common. In the study, the changes were more prominent in cases of severe acidosis. A retrospective chart review of 9 patients between 2006 and 2011 revealed that lower pH and higher plasma methanol concentration were associated with multiple ECG changes. On admission, ECG changes included sinus tachycardia (44%), PR prolongation (11%), QTc prolongation (22%), and non-specific T-wave changes (66%). One patient developed a type-1 Brugada ECG pattern. [2]

According to Zakharov et al, S-formate measurement can help in the laboratory diagnosis and clinical management of acute methanol poisoning. In their study of 38 patients from a Czech methanol mass poisoning in 2012, S-formate levels ≥3.7 mmol/L were seen to lead to the first clinical signs of visual toxicity, indicating hemodialysis. S-formate ≥11-12 mmol/L was associated with visual/CNS sequelae and a lethal outcome. The probability of a poor outcome (death or survival with sequelae) was higher than 90% in patients with S-formate levels ≥17.5 mmol/L, S-lactate levels ≥7.0 mmol/L, and/or pH < 6.87. [3]


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