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Two cases of acute methanol poisoning partially treated by oral 4-methylpyrazole.

Author(s): Hantson P, Wallemacq P, Brau M, Vanbinst R, Haufroid V, Mahieu P

Affiliation(s): Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium. hantson@rean.ucl.ac.be

Publication date & source: 1999-05, Intensive Care Med., 25(5):528-31.

Publication type: Case Reports

OBJECTIVE: Since the use of 4-methylpyrazole (4-MP) in the treatment of humans with methanol poisoning is poorly documented, we report two cases of acute methanol intoxication partially treated by this potent alcohol dehydrogenase (ADH) inhibitor. SETTING: Intensive Care Unit in a university hospital. PATIENTS: A 56-year-old man and an 18-year-old woman were observed, respectively, 41 and 16 h after the voluntary ingestion of an unknown amount of methanol. INTERVENTION: In both cases, ethanol was used as the first antidote. In the first patient, hemodialysis was also performed on admission because a high methanol level (0.72 g/l) and visual impairment were noted. In the second patient, ethanol therapy was withdrawn after 12 h when clinical and biological signs of acute pancreatitis became evident. Both patients received multiple oral doses of 4-MP. No recurrence of metabolic acidosis occurred and the 4-MP therapy was well tolerated. CONCLUSION: While the use of 4-MP is better documented in cases of ethylene glycol poisoning, it could also become an accepted option for the management of methanol poisoning since 4-MP offers advantages over ethanol therapy.

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