METHANOL

Dr keli Med IIIlectures

Methanol
Industrial product Commercial solvent Used as alcoholics as a substitute Toxiicty is due to folate depended formation of fomate The most characteristic symptom is visual disturbance blurred vision, visual loss

MECHANISM OF ACTION
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC ACID

MECHANISM OF ACTION
METHANOL

OCULAR TOXICITY
INHIBITION OF MITOCHONDRIAL RESPIRATION INCREASED FORMIC ACID TOXICITY

FORMALDEHYDE

FORMIC ACID

CIRCULATORY FAILURE TISSUE HYPOXIA

CIRCULUS HYPOXICUS
LACTIC ACID PRODUCTION

ACIDOSIS

ACIDOSIS

Early stage of poisoning

GENERAL TOXICITY

SIGNS AND SYMPTOMS

INITIAL INEBRIATION - ESPECIALLY IF ETHANOL COINGESTED

AFTER 12 - 24 HOUR DELAY - PROGRESSION TO ACIDOSIS AND OTHER SIGNS AND SYMPTOMS

MAY BE FURTHER DELAY WITH CONTINUED INGESTION OF ETHANOL

SIGNS AND SYMPTOMS

CNS - INEBRIATION PROGRESSING TO COMA, CONVULSIONS RETINAL - BLURRED VISION, PHOTOPHOBIA, VISUAL ACUITY LOSS, DILATED NON-REACTIVE PUPILS, OPTIC NERVE HYPERAEMIC - BECOMING OEDEMATOUS GIT - NAUSEA, VOMITING CARDIAC - TACHYCARDIA, HYPERTENSION PROGRESSING TO HYPOTENSION AND CARDIOGENIC SHOCK RESPIRATORY - TACHYPNOEA

INVESTIGATION
BLOOD METHANOL LEVEL! ABG - METABOLIC ACIDOSIS OSMOLAL GAP - INCREASED (METHANOL) ANION GAP - INCREASED (FORMIC ACID, LACTIC ACID) BLOOD ETHANOL MAGNESIUM, AMYLASE, POTASSIUM

TREATMENT
HAZARD ASSESSMENT ABCs TOXICOKINETICS ABSORPTION DISTRIBUTION METABOLISM ELIMINATION

TOXICODYNAMICS SUPPORTIVE CARE

TREATMENT
CORRECTION OF METABOLIC ACIDOSIS BICARBONATE (AGGRESSIVE TREATMENT) CAN REVERSE VISUAL IMPAIRMENT REDUCES MOVEMENT OF FORMATE TO THE CNS MAY REQUIRE 400 TO 600 MMOL DURING FIRST FEW HOURS

REHYDRATION

MECHANISM OF ACTION
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC ACID

MECHANISM OF ACTION

METHANOL

FORMALDEHYDE

FORMIC ACID

ALCOHOL DEHYDROGENASE

ALDEHYDE DEHYDROGENASE

ETHANOL

ALDEHYDE

ACETIC ACID

TREATMENT
ETHANOL
(REDUCES FORMATION OF TOXIC METABOLITES)

MAINTAIN BLOOD ETHANOL LEVEL OF 100 - 150 mg/dl LOADING DOSE BEWARE OF EXISTING ETHANOL LEVEL MAINTENANCE DOSE TITRATED AGAINST RATE OF ELIMINATION NON-ALCOHOLIC CHRONIC ALCOHOLIC CHILD 15 - 20 mg/dl/h 30 - 40 mg/dl/h 30 mg/dl/h

TREATMENT
ETHANOL

INDICATIONS BLOOD METHANOL LEVELS GREATER THAN 6.25 mmol/l (20 mg/dl) IF HAEMODIALYSIS IS TO BE COMMENCED

TREATMENT
ETHANOL

HALF LIFE OF METHANOL IS USUALLY 15 - 30 HOURS

HALF LIFE OF METHANOL WITH ETHANOL TREATMENT IS 45 - 50 HOURS

YOU MAY THEREFORE HAVE A NON-SOBER PATIENT ON THE WARD FOR SEVERAL (4 - 5) DAYS...

TREATMENT
HAEMODIALYSIS

METHANOL LOW MOLECULAR WEIGHT NOT PROTEIN BOUND LOW VOLUME OF DISTRIBUTION THEREFORE IDEAL FOR HAEMODIALYSIS

TREATMENT
HAEMODIALYSIS

INDICATIONS
ANY DEGREE OF VISUAL IMPAIRMENT

SEVERE METABOLIC ACIDOSIS

BLOOD METHANOL LEVEL GREATER THAN 15 mmol/l (50mg/dl)

METABOLISM
ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC ACID

FOLIC ACID MAGNESIUM

THF

CO2 and H2O

TREATMENT
FOLINIC ACID/FOLIC ACID 50 mg IV EVERY FOUR HOURS FOR 24 HOURS, OR WHILE FORMIC ACID MAY STILL BE ACCUMULATING

MAGNESIUM MgSO4 TITRATED AGAINST BLOOD MAGNESIUM LEVELS