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Indications for Hemodialysis in a Patient with Methanol Poisoning Being Treated with Fomepizole

Description

Hemodialysis may aid in the rapid clearance of toxic levels of methanol. Certain clinical or laboratory findings can identify a patient who may benefit from the procedure. These indications are for patients who have been started therapy with fomepizole, an inhibitor of alcohol dehydrogenase that blocks metabolism of the methanol to formaldehyde and formic acid.


 

Indications for hemodialysis in a patient with methanol poisoning include the presence of one or more of the following:

(1) initial arterial pH < 7.1

(2) decrease in arterial pH by 0.05 or more units despite bicarbonate supplementation

(3) decrease in serum bicarbonate by more than 5 mmol/L despite bicarbonate supplementation

(4) serum methanol > 50 mg/dL (15.6 mmol/L)

(5) visual signs or symptoms

(6) failure of the serum methanol to decline >= 10 mg/dL (3.1 mmol/L) per 24 hours during treatment

 


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