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What Is the Treatment for Methanol Poisoning?

By Rebecca Harkin
Updated Mar 03, 2024
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Treatment for methanol poisoning typically involves removing and neutralizing the methanol still in the stomach, neutralizing metabolic acidosis and preventing the remaining methanol from being broken down, and removing the un-metabolized methanol and any remaining methanol metabolites. When methanol is ingested, the body breaks down the compound into toxic parts or metabolites which causes metabolic acidosis, and blood and other body fluids become highly acidic. Metabolic acidosis can be fatal if not treated quickly.

If a patient is discovered soon after ingesting methanol, quick action can be performed by the emergency response team to remove any methanol still in the stomach by inducing vomiting or pumping out the poison. Activated charcoal, a fairly universal poison neutralizer, is often administered, although this is not an evidence-based practice. Unfortunately, activated charcoal is not particularly effective at absorbing methanol, or other alcohols. Any methanol that was digested by the stomach or reached the digestive tract before the stomach pumping will be broken down and begin to poison the body.

The second stage of treatment for methanol poisoning is to neutralize the metabolic acidosis caused by the metabolism of methanol to formic acid. Diagnosis of metabolic acidosis is difficult unless methanol poisoning is suspected because symptoms are fairly general and include vomiting, chest pain, heart palpitations, and an anxious mental state. Treatment begins by performing an arterial blood gas to test the body's pH level, or how acidic the blood is, and the bicarbonate level, or the ability of the blood to buffer against elevated acid levels. To neutralize the elevated acid level, sodium bicarbonate will be administered intravenously to regulate the pH balance, and folinic or folic acid will be given to help metabolize the formic acid. The patient will often be given intravenous fluids and electrolytes, airway management, and be evaluated and treated for any existing neurological or cardiovascular problems resulting from the methanol poisoning.

In the third stage of treatment, the goal is to prevent further metabolism of the methanol and to remove unmetabolized methanol and any remaining toxic metabolites. Alcohol dehydrogenases are enzymes which catalyze the breakdown of alcohols and, in the case of methanol poisoning, allow for the breakdown of methanol to formic acid. Ethanol or fomepizole are typically administered to prevent the metabolism of methanol because they act as competitive inhibitors to alcohol dehydrogenases, meaning they bind to alcohol dehydrogenases and leave them inactive and useless. As a result, ethanol or fomepizole prevents or slows the metabolism of methanol into its toxic byproducts, allowing methanol to be eliminated through the kidneys. Hemodialysis will also be performed to clear the blood of any methanol and formic acid still remaining.

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Discussion Comments
By anon1001844 — On Jul 07, 2019

Methanol (along with other toxic alcohols) are poorly adsorbed by activated charcoal. Therefore, activated charcoal would not be useful in the management of methanol ingestion. It is often given in emergency departments as the sad reality is that many ED's are staffed by providers who are not board certified emergency physicians and they will often give activated charcoal for any and all ingestions, even though this is not an evidence based practice.

By ZipLine — On Aug 08, 2014

Dialysis must be the scariest part about methanol poisoning treatment. I think it involves cleaning the blood through the use of a machine that pumps blood out and then pumps it back in. But if it's necessary, it has to be done because it will save a life. It's basically the last option that doctors will use if nothing else is working.

By fify — On Aug 07, 2014

I had no idea that sodium bicarbonate can be administered intravenously. I knew that bicarbonate can help neutralize acidity. That's why it's often an ingredient in antacids for people with acidic stomachs. But I'm hearing about its use in methanol poisoning for the first time. It's great if something so simple can help treat methanol poisoning and reduce its effects.

By SteamLouis — On Aug 07, 2014

My cousin was in the hospital recently for methanol poisoning. He went in as soon as he realized what had happened. In the hospital, they told him that either he has to drink activated charcoal, or his stomach will be pumped. I guess the idea of having his stomach pumped was very scary to him because he chugged down a huge glass of activated charcoal. He said he had to really force the last gulp down because it tasted so awful.

Thankfully though, since he was treated quickly and most of the methanol did not get digested by the body, he did not suffer serious consequences. If he had gone into the hospital later though, I'm sure he would have had many issues.

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