Background

• 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

   

  Clinical

• 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)

   

  Diagnosis

• 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)

   

  Treatment

• 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

   

  REFERENCES

   

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