Back to Basics: Methanol and Ethylene Glycol Toxicity


  • Methanol found in paint products, windshield wiper fluid, and antifreeze

  • Ethylene glycol found in antifreeze, brake fluid, and some detergents

  • Methanol and ethylene glycol are metabolized in the liver to toxic compounds by alcohol dehydrogenase



  • Methanol Poisoning = symptoms often occur 12 to 24 hrs after ingestion, altered mental status / visual problems / abdominal pain / nausea / vomiting, gastritis / pancreatitis, papilledema

  • Ethylene Glycol Poisoning = initial 12 hrs present as intoxication (nausea / vomit / slurred speech / ataxia / altered mental status), 12 to 24 hrs after ingestion predominately cardiopulmonary effects (tachycardia, tachypnea, hypertension, CHF, ARDS), 24+ hrs after ingestion predominately renal effects (flank pain, hematuria, oliguria / anuria, ATN, ARF)



  • Metabolic acidosis with elevated anion gap and elevated osmolal gap

  • Serum methanol and ethylene glycol levels available at most labs

  • Calcium oxalate crystals in urine with ethylene glycol

  • VBG / ABG useful to assess severity of acidosis

  • ECG : ethylene glycol can cause hypocalcemia (prolonged QT interval)



  • Supportive care

  • Fomepizole and ethanol both have greater affinity for alcohol dehydrogenase and can block metabolism to toxic compounds

  • Methanol, ethylene glycol, and their toxic metabolites are all dialyzable

  • Other: methanol - folate, ethylene glycol - pyridoxine and thiamine




    Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.