METHANOL

General Recommendation

Indications

ECTR is recommended if ANY of the following conditions are present:

Coma (Grade 1D)
Seizures (Grade 1D)
New vision deficits (Grade 1D)
Blood pH ≤7.15 (Grade 1D)
Persistent metabolic acidosis despite adequate supportive measures and antidotes (Grade 1D)
Serum anion gap higher than 24 mmol/L (Grade 1D); calculated by serum [Na+] – [Cl-] – [HCO3-].
Serum methanol concentration greater than 700 mg/L (21.8 mmol/L) in the context of fomepizole therapy (Grade 1D)
Serum methanol concentration greater than 600 mg/L (18.7 mmol/L) in the context of ethanol treatment (Grade 1D)
Serum methanol concentration greater than 500 mg/L (15.6 mmol/L) in the absence of an ADH blocker (Grade 1D)
In the absence of a methanol concentration, the osmol gap may be informative (Grade 1D)
In context of impaired kidney function (Grade 1D)

Cessation of ECTR

ECTR can be terminated when the methanol concentration is <200 mg/L (6.2 mmol/L) and a clinical improvement is observed (Grade 1D)

Choice of ECTR

Intermittent hemodialysis is the modality of choice in methanol poisoning (Grade 1D)
Continuous modalities are acceptable alternatives if intermittent hemodialysis is not available (Grade 1D)

Miscellaneous

ADH inhibitors are to be continued during ECTR for methanol poisoning (Grade 1D); as well as folic acid

Blood Purification in Toxicology:​Reviewing the Evidence and Providing Recommendations