Barceloux et al reported a protocol for treatment of a patient with methanol poisoning. A similar protocol can be used in patients with other toxic alcohol ingestions when fomepizole is not available. The authors are from the American Academy of Clinical Toxicology.
molecular weight methanol: 32.04 g
density of ethanol: 0.789 g per cc (789 mg/mL)
an 86 proof (43% solution) for oral administration: 339.27 mg/mL
an 80 proof (40%) solution for oral administration: 315.6 mg/mL
a 20 proof (10%) solution for intravenous infusion: 78.9 mg/mL
An ethanol solution for oral administration would be less than 101 proof.
Goals of therapy:
(1) serum ethanol concentration during therapy of 100 mg/dL
(2) serum methanol concentration reduced to < 20 mg/dL
(3) patient asymptomatic with normal arterial pH
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Dose
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Amount of Absolute Ethanol
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loading dose (approximate)
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600 mg per kg
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standard maintenance dose in nondrinker
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66 mg per kg per hour
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standard maintenance dose in heavy drinker
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154 mg per kg per hour
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If the patient's serum ethanol concentration is already elevated, then a lower loading dose can be used.
If the patient is started on dialysis then a higher dose is needed.
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Dose
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Amount of Absolute Ethanol
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maintenance dose in nondrinker with dialysis
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169 mg per kg per hour
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maintenance dose in heavy drinker with dialysis
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257 mg per kg per hour
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Converting a dose in mg to mL:
dose in mL =
= (dose in mg) / (density of solution)
