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Methanol Poisoning

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General Recommendation

  • ECTR is recommended in severe methanol poisoning (1D)

 

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 or 21.8 mmol/L in the context of fomepizole therapy (Grade 1D)

  • Serum methanol concentration greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment (Grade 1D) 

  • Serum methanol concentration greater than 500 mg/L or 15.6 mmol/L in the absence of an ADH blocker (Grade 1D)

  • In the absence of a methanol concentration, the osmolal/osmolar 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 or 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