Back to Browse Journals » Open Access Emergency Medicine » Volume 2

Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole

Authors Bruno Mégarbane

Published Date August 2010 Volume 2010:2 Pages 67—75

DOI http://dx.doi.org/10.2147/OAEM.S5346

Published 26 August 2010

Bruno Mégarbane
Réanimation Médicale et Toxicologique, Hôpital Lariboisière and Université Paris-Diderot, Paris, France
Abstract: Ethylene glycol (EG) and methanol are responsible for life-threatening poisonings. Fomepizole, a potent alcohol dehydrogenase (ADH) inhibitor, is an efficient and safe antidote that prevents or reduces toxic EG and methanol metabolism. Although no study has compared its efficacy with ethanol, fomepizole is recommended as a first-line antidote. Treatment should be started as soon as possible, based on history and initial findings including anion gap metabolic acidosis, while awaiting measurement of alcohol concentration. Administration is easy (15 mg/kg-loading dose, either intravenously or orally, independent of alcohol concentration, followed by intermittent 10 mg/kg-doses every 12 hours until alcohol concentrations are <30 mg/dl). There is no need to monitor fomepizole concentrations. Administered early, fomepizole prevents EG-related renal failure and methanol-related visual and neurological injuries. When administered prior to the onset of significant acidosis or organ injury, fomepizole may obviate the need for hemodialysis. When dialysis is indicated, 1 mg/kg/h-continuous infusion should be provided to compensate for its elimination. Side-effects are rarely serious and with a lower occurrence than ethanol. Fomepizole is contraindicated in case of allergy to pyrazoles. It is both efficacious and safe in the pediatric population, but is not recommended during pregnancy. In conclusion, fomepizole is an effective and safe first-line antidote for EG and methanol intoxications.
Keywords: ethanol, hemodialysis, metabolic acidosis

Download Article [PDF] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Readers of this article also read:

Uptake of bright fluorophore core-silica shell nanoparticles by biological systems

Zane A, McCracken C, Knight DA, Young T, Lutton AD, Olesik JW, Waldman WJ, Dutta PK

International Journal of Nanomedicine 2015, 10:1547-1567

Published Date: 20 February 2015

Layer-by-layer paper-stacking nanofibrous membranes to deliver adipose-derived stem cells for bone regeneration

Wan W, Zhang S, Ge L, Li Q, Fang X, Yuan Q, Zhong W, Ouyang J, Xing M

International Journal of Nanomedicine 2015, 10:1273-1290

Published Date: 12 February 2015

Value of portal venous system radiological indices in predicting esophageal varices

Gaduputi V, Patel H, Sakam S, Neshangi S, Ahmed R, Lombino M, Chilimuri S

Clinical and Experimental Gastroenterology 2015, 8:89-93

Published Date: 9 February 2015

Nanocomplexation of thrombin with cationic amylose derivative for improved stability and hemostatic efficacy

Zhuang B, Li Z, Pang J, Li W, Huang P, Wang J, Zhou Y, Lin Q, Zhou Q, Ye X, Ye H, Liu Y, Zhang LM, Chen R

International Journal of Nanomedicine 2015, 10:939-947

Published Date: 29 January 2015

Multifunction hexagonal liquid-crystal containing modified surface TiO2 nanoparticles and terpinen-4-ol for controlled release

Manaia EB, Kaminski RCK, Oliveira AG, CorrĂȘa MA, Chiavacci LA

International Journal of Nanomedicine 2015, 10:811-819

Published Date: 22 January 2015

Real-world effectiveness of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide in high-risk patients and other subgroups

Assaad-Khalil SH, Najem R, Sison J, Kitchlew AR, Cho BL, Ueng KC, DiTommaso S, Shete A

Vascular Health and Risk Management 2015, 11:71-78

Published Date: 21 January 2015

Evaluation of in vitro glistening formation in hydrophobic acrylic intraocular lenses

Thomes BE, Callaghan TA

Clinical Ophthalmology 2013, 7:1529-1534

Published Date: 25 July 2013