Severe methanol ingestion treated successfully without hemodialysis

Methanol Induced Optic Neuropathy: Molecular Mysteries, Public Health Perspective, Clinical Insights and Treatment Strategies

Methanol-induced optic neuropathy (MION) represents a critical public health issue, particularly prevalent in lower socioeconomic populations and regions with restricted alcohol access. MION, characterized by irreversible visual impairment, arises from the toxic metabolization of methanol into formaldehyde and formic acid, leading to mitochondrial oxidative phosphorylation inhibition, oxidative stress, and subsequent neurotoxicity. The pathogenesis involves axonal and glial cell degeneration within the optic nerve and potential retinal damage. Despite advancements in therapeutic interventions, a significant proportion of affected individuals endure persistent visual sequelae. The study comprehensively investigates the pathophysiology of MION, encompassing the absorption and metabolism of methanol, subsequent systemic effects, and ocular impacts. Histopathological changes, including alterations in retinal layers and proteins, Müller cell dysfunction, and visual symptoms, are meticulously examined to provide insights into the disease mechanism. Furthermore, preventive measures and public health perspectives are discussed to highlight the importance of awareness and intervention strategies. Therapeutic approaches, such as decontamination procedures, ethanol and fomepizole administration, hemodialysis, intravenous fluids, electrolyte balance management, nutritional therapy, corticosteroid therapy, and erythropoietin (EPO) treatment, are evaluated for their efficacy in managing MION. This comprehensive review underscores the need for increased awareness, improved diagnostic strategies, and more effective treatments to mitigate the impact of MION on global health.

Methanol poisoning as a new world challenge: A review

Background

Methanol poisoning (MP) occurs often via ingestion, inhalation, or dermal exposure to formulations containing methanol in base. Clinical manifestations of MP include gastrointestinal symptoms, central nervous system (CNS) suppression, and decompensated metabolic acidosis occurred with blurred vision and early or late blindness.

Objective

This study reviewed the clinical manifestations, laboratory and radiology findings, and treatment approaches in MP.

Discussion

Methanol is usually rapidly absorbed after ingestion and metabolized by alcohol dehydrogenase (ADH), then distributed to the body water to reach a volume distribution approximately equal to 0.77 L/kg. It is also eliminated from the body as unchanged parent compounds. Clinical manifestations of MP alone initiate within 0.5–4 h after ingestion and include gastrointestinal symptoms and CNS suppression. After a latent period of 6–24 h, depending on the absorbed dose, decompensated metabolic acidosis occurs with blurred vision and early or late blindness. Blurred vision with normal consciousness is a strong suspicious sign of an MP. The mortality and severity of intoxication are well associated with the severity of CNS depression, hyperglycemia, and metabolic acidosis, but not with serum methanol concentration. After initial resuscitation, the most important therapeutic action for patients with known or suspected MP is correction of acidosis, inhibition of ADH, and hemodialysis.

Conclusion

Since MP is associated with high morbidity and mortality, it should be considered seriously and instantly managed. Delay in treatment may cause complications, permanent damage, and even death.

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We attempt to review clinical manifestations, laboratory and radiology findings, and treatment approaches in Methanol poisoning (MP).

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The most important therapeutic action for patients with known MP is correction of acidosis, inhibition of alcohol dehydrogenase, and hemodialysis.

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The review emphasizes that MP has a high morbidity and mortality rate and it must be taken seriously and treated immediatly.

Use of Fomepizole in Pediatric Methanol Exposure: The First Case Report in Taiwan and a Literature Review

Methanol poisoning is rare in the pediatric population, but a delay in diagnosis and intervention may cause severe morbidity and mortality. The current therapy for methanol poisoning is ethanol or fomepizole, which acts as a competitive inhibitor of hepatic alcohol dehydrogenase to inhibit the production of toxic metabolites derived from the oxidation of methanol. However, clinical experience in pediatric methanol poisoning is limited, and the safety profiles of the antidotes have not been established in children, especially in Asian populations. This is the first case to describe the use of fomepizole in a child with methanol exposure in Taiwan.

Short-term immunological effects of non-ethanolic short-chain alcohols

Short-chain alcohols are embedded into several aspects of modern life. The societal costs emanating from the long history of use and abuse of the prototypical example of these molecules, ethanol, have stimulated considerable interest in its general toxicology. A much more modest picture exists for other short-chain alcohols, notably as regards their immunotoxicity. A large segment of the general population is potentially exposed to two of these alcohols, methanol and isopropanol. Their ubiquitous nature and their eventual use as ethanol surrogates are predictably associated to accidental or deliberate poisoning. This review addresses the immunological consequences of acute exposure to methanol and isopropanol. It first examines the general mechanisms of short-chain alcohol-induced biological dysregulation and then provides a tentative model to explain the molecular events that underlie the immunological dysfunction produced by methanol and isopropanol. The time-related context of serum alcohol concentrations in acute poisoning, as well as the clinical implications of their short-term immunotoxicity, is also discussed.