Effectiveness of IV Ethanol Therapy Combined with Hemodialysis in the Treatment of Methanol and Ethylene Glycol Poisoning

Background: The management of methanol and ethylene glycol poisoning includes inhibition of alcohol dehydrogenase by IV ethanol therapy or fomepizole. There is a lack of contemporary information on IV administration of ethanol in this setting. Objective: To evaluate the effectiveness of IV ethanol therapy in combination with hemodialysis for the treatment of methanol and ethylene glycol poisoning. Methods: The medical records of patients with methanol or ethylene glycol poisoning who had been treated with at least 6 h of IV ethanol therapy were reviewed. Patients were included in the study if initial serum methanol or ethylene glycol concentration was at least 6.2 or 3.2 mmol/L, respectively, or if the laboratory findings were consistent with poisoning. Outcomes included in-hospital death, incidence of visual disturbances secondary to methanol poisoning, incidence of renal dysfunction secondary to ethylene glycol poisoning, incidence of hypoglycemia secondary to IV ethanol therapy, and success in achieving target ethanol concentration of greater than 22 mmol/L. Results: Twenty-seven patients met the eligibility criteria, 25 of whom survived. Twenty-six of the 27 patients underwent concurrent hemodialysis. Renal dysfunction occurred in 2 of 11 patients with ethylene glycol poisoning, and 1 of these patients required long-term dialysis. No visual disturbances secondary to methanol poisoning were documented, and there were no episodes of hypoglycemia in any patient during infusion of ethanol. In 56% of all serum samples obtained during ethanol treatment, the ethanol concentrations were above the threshold of 22 mmol/L. Conclusion: IV administration of ethanol, combined with hemodialysis, appears to be effective and safe for the management of patients with methanol and ethylene glycol poisoning.