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METHANOL POISONING Management with Ethanol. MECHANISM OF ACTION. ALCOHOL DEHYDROGENASE. ALDEHYDE DEHYDROGENASE. METHANOL. FORMALDEHYDE. FORMIC ACID. MECHANISM OF ACTION. METHANOL. FORMALDEHYDE. OCULAR TOXICITY. INHIBITION OF MITOCHONDRIAL RESPIRATION. INCREASED FORMIC ACID TOXICITY.

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METHANOL

POISONING

Management with Ethanol


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MECHANISM OF ACTION

ALCOHOL DEHYDROGENASE

ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC

ACID


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MECHANISM OF ACTION

METHANOL

FORMALDEHYDE

OCULAR

TOXICITY

INHIBITION OF MITOCHONDRIAL RESPIRATION

INCREASED FORMIC ACID TOXICITY

FORMIC

ACID

CIRCULATORY

FAILURE

CIRCULUS

HYPOXICUS

TISSUE

HYPOXIA

ACIDOSIS

ACIDOSIS

LACTIC ACID

PRODUCTION

Early stage

of poisoning

GENERAL TOXICITY


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SIGNS AND SYMPTOMS

INITIAL INEBRIATION - ESPECIALLY IF ETHANOL

COINGESTED

AFTER 12 - 24 HOUR DELAY - PROGRESSION TO ACIDOSIS

AND OTHER SIGNS AND SYMPTOMS

MAY BE FURTHER DELAY WITH CONTINUED INGESTION

OF ETHANOL


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SIGNS AND SYMPTOMS

CNS - INEBRIATION PROGRESSING TO COMA,

CONVULSIONS

RETINAL - BLURRED VISION, PHOTOPHOBIA, VISUAL

ACUITY LOSS, DILATED NON-REACTIVE PUPILS,

OPTIC NERVE HYPERAEMIC - BECOMING OEDEMATOUS

GIT - NAUSEA, VOMITING

CARDIAC - TACHYCARDIA, HYPERTENSION PROGRESSING

TO HYPOTENSION AND CARDIOGENIC SHOCK

RESPIRATORY - TACHYPNOEA


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INVESTIGATION

BLOOD METHANOL LEVEL!

ABG - METABOLIC ACIDOSIS

OSMOLAL GAP - INCREASED (METHANOL)

ANION GAP - INCREASED (FORMIC ACID, LACTIC ACID)

BLOOD ETHANOL

MAGNESIUM, AMYLASE, POTASSIUM


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TREATMENT

HAZARD ASSESSMENT

ABC’s

TOXICOKINETICS

ABSORPTION

DISTRIBUTION

METABOLISM

ELIMINATION

TOXICODYNAMICS

SUPPORTIVE CARE


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TREATMENT

CORRECTION OF METABOLIC ACIDOSIS

BICARBONATE (AGGRESSIVE TREATMENT)

CAN REVERSE VISUAL IMPAIRMENT

REDUCES MOVEMENT OF FORMATE TO THE CNS

MAY REQUIRE 400 TO 600 MMOL DURING FIRST FEW HOURS

REHYDRATION


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MECHANISM OF ACTION

ALCOHOL DEHYDROGENASE

ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC

ACID


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MECHANISM OF ACTION

X

METHANOL

FORMALDEHYDE

FORMIC

ACID

ALCOHOL DEHYDROGENASE

ALDEHYDE DEHYDROGENASE

ETHANOL

ALDEHYDE

ACETIC

ACID


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TREATMENT

ETHANOL

(REDUCES FORMATION OF TOXIC METABOLITES)

MAINTAIN BLOOD ETHANOL LEVEL OF 100 - 150 mg/dl

LOADING DOSE

BEWARE OF EXISTING ETHANOL LEVEL

MAINTENANCE DOSE

TITRATED AGAINST RATE OF ELIMINATION

NON-ALCOHOLIC 15 - 20 mg/dl/h

CHRONIC ALCOHOLIC 30 - 40 mg/dl/h

CHILD 30 mg/dl/h


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TREATMENT

ETHANOL

INDICATIONS

BLOOD METHANOL LEVELS GREATER THAN

6.25 mmol/l (20 mg/dl)

IF HAEMODIALYSIS IS TO BE COMMENCED


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TREATMENT

ETHANOL

HALF LIFE OF METHANOL IS USUALLY 15 - 30 HOURS

HALF LIFE OF METHANOL WITH ETHANOL TREATMENT

IS 45 - 50 HOURS

YOU MAY THEREFORE HAVE A NON-SOBER PATIENT ON

THE WARD FOR SEVERAL (4 - 5) DAYS...


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TREATMENT

HAEMODIALYSIS

METHANOL

LOW MOLECULAR WEIGHT

NOT PROTEIN BOUND

LOW VOLUME OF DISTRIBUTION

THEREFORE IDEAL FOR HAEMODIALYSIS


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TREATMENT

HAEMODIALYSIS

INDICATIONS

ANY DEGREE OF VISUAL IMPAIRMENT

SEVERE METABOLIC ACIDOSIS

BLOOD METHANOL LEVEL GREATER THAN

15 mmol/l (50mg/dl)


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METABOLISM

ALCOHOL DEHYDROGENASE

ALDEHYDE DEHYDROGENASE

METHANOL

FORMALDEHYDE

FORMIC

ACID

FOLIC ACID

THF

MAGNESIUM

CO2 and H2O


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TREATMENT

FOLINIC ACID/FOLIC ACID

50 mg IV EVERY FOUR HOURS FOR 24 HOURS, OR WHILE

FORMIC ACID MAY STILL BE ACCUMULATING

MAGNESIUM

MgSO4 TITRATED AGAINST BLOOD MAGNESIUM LEVELS


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METHYLATED SPIRITS

METHYLATED SPIRITS IS 5% METHANOL, 95% ETHANOL

ACUTE INGESTION PRESENTS AS ETHANOL, RATHER THAN

METHANOL, POISONING

METHANOL INTOXICATION IS ONLY A CONCERN IF METHYLATED

SPIRSTS IS INGESTED CHRONICALLY


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METHYLATED SPIRITS

EXAMPLE

IF 250 ml METHYLATED SPIRITS INGESTED:

BLOOD ETHANOL LEVEL = 450 mg/dl (LD50)

BLOOD METHANOL LEVEL = 24 mg/dl


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METHYLATED SPIRITS

EXAMPLE

IF 1.5 l METHYLATED SPIRITS INGESTED OVER SEVERAL

DAYS:

BLOOD ETHANOL LEVEL ~ 450 mg/dl (LD50)

BLOOD METHANOL LEVEL = 142 mg/dl

(IN 12 HOURS ETHANOL LEVEL = 100 mg/dl

METHANOL LEVEL = 124 mg/dl)


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