Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole
Bruno MégarbaneRéanimation Médicale et Toxicologique, Hôpital Lariboisière and Université Paris-Diderot, Paris, FranceAbstract: Ethylene glycol (EG) and methanol are responsible for life-threatening poisonings....
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2010-08-01
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| Series: | Open Access Emergency Medicine |
| Online Access: | http://www.dovepress.com/treatment-of-patients-with-ethylene-glycol-or-methanol-poisoning-focus-a5128 |
| _version_ | 1818139084255657984 |
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| author | Bruno Mégarbane |
| author_facet | Bruno Mégarbane |
| author_sort | Bruno Mégarbane |
| collection | DOAJ |
| description | Bruno MégarbaneRéanimation Médicale et Toxicologique, Hôpital Lariboisière and Université Paris-Diderot, Paris, FranceAbstract: 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 |
| first_indexed | 2024-12-11T10:22:28Z |
| format | Article |
| id | doaj.art-5ef83ff11bc348aeba1310d75f462fa3 |
| institution | Directory Open Access Journal |
| issn | 1179-1500 |
| language | English |
| last_indexed | 2024-12-11T10:22:28Z |
| publishDate | 2010-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Open Access Emergency Medicine |
| spelling | doaj.art-5ef83ff11bc348aeba1310d75f462fa32022-12-22T01:11:20ZengDove Medical PressOpen Access Emergency Medicine1179-15002010-08-012010default6775Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizoleBruno MégarbaneBruno MégarbaneRéanimation Médicale et Toxicologique, Hôpital Lariboisière and Université Paris-Diderot, Paris, FranceAbstract: 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 acidosishttp://www.dovepress.com/treatment-of-patients-with-ethylene-glycol-or-methanol-poisoning-focus-a5128 |
| spellingShingle | Bruno Mégarbane Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole Open Access Emergency Medicine |
| title | Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole |
| title_full | Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole |
| title_fullStr | Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole |
| title_full_unstemmed | Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole |
| title_short | Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole |
| title_sort | treatment of patients with ethylene glycol or methanol poisoning focus on fomepizole |
| url | http://www.dovepress.com/treatment-of-patients-with-ethylene-glycol-or-methanol-poisoning-focus-a5128 |
| work_keys_str_mv | AT brunomampeacutegarbane treatmentofpatientswithethyleneglycolormethanolpoisoningfocusonfomepizole |