Fomepizole (4-Methylpyrazole) in Fatal Methanol Poisoning with Early CT Scan Cerebral Lesions

Background: Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowle...

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Bibliographic Details
Published in:Journal of toxicology. Clinical toxicology 1999, Vol.37 (6), p.777-780
Main Authors: Girault, Christophe, Tamion, Fabienne, Moritz, Fabienne, Callonnec, Françoise, Droy, Jean-Michel, Bonmarchand, Guy, Leroy, Jacques
Format: Article
Language:English
Subjects:
Acidosis - chemically induced
Acidosis - drug therapy
Adult
Alcohol Dehydrogenase - antagonists & inhibitors
Antidotes - therapeutic use
Biological and medical sciences
Brain - diagnostic imaging
Brain - drug effects
Chemical and industrial products toxicology. Toxic occupational diseases
Coma - chemically induced
Coma - drug therapy
Dialysis
Enzyme Inhibitors - therapeutic use
Fatal Outcome
Female
Fomepizole
Humans
Medical sciences
Methanol - pharmacokinetics
Methanol - poisoning
Pyrazoles - therapeutic use
Suicide, Attempted
Tomography, X-Ray Computed
Toxicology
Various organic compounds
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Summary:Background: Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis.Case Report: We report a case of fatal methanol poisoning (1.9g L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. Conclusion: The fomepizole treatment protocol (10 mg kg by IV infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg kg h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.
ISSN:0731-3810
1097-9875
DOI:10.1081/CLT-100102456