[Right Wing Assault]

Presentation

* Signifcant ingestion causes nausea, vomiting and abdo pain. Its effects on the CNS resemble those of ethanol although in low doses it does not have a euphoric effect.
* Visual symptoms present with falling visual acuity, photophobia and the sensation of ‘being in a snow storm’.

Complications

* Up to 2/3rds of patients have a raised amylase (haemorrhagic pancreatitis has been reported at post mortem)
* Seizures are seen in severe intoxication. CT scanning usually shows cerebral oedema or even necrosis in the basal ganglia (a Parkinsonian-like state is sometimes seen with recovery).
* Patients with visual symptoms may develop irreversible visual impairment even with aggressive intervention.

Prognostic features

* Ingestion of only 10ml can cause blindness and 30ml can be fatal.
* Peak plasma methanol is useful although in practice the ‘peak’ is often unclear; >0.2g/1 (6.25 mmol/l) indicates significant ingestion and 0.5g/1 (15.6 mmol/l) is severe (c.f. driving limit for plasma ethanol of 17.4 mmol/L).
* Arterial pH seems to correlate best with formate levels and pH (< 7.2 is a severe intoxication).

Management

* Ipecac/gastric lavage is useful only if presenting within 2 hours of ingestion. Activated charcoal is not indicated.
* Seizures are probably best treated with phenytoin (250mg IV over 5 mins) since this will have less of a CNS depressant effect than diazepam NB exclude hypoglycaemia before giving any anticonvulsant.
* Specific antidote is ethanol and this should be given IV as a 10% solution in 5% dextrose A loading dose of 0.6g/kg should be given followed by an lVI of 0.07g/kg/hr for non-drinkers (regular drinkers should receive 0. 16g/kg/hr):

Ethanol levels should be checked to ensure they are within the treatment range 1-1.5g/L (21.7-32.6 mmol/L). Ethanol should be given to: (1) all patients pending MeOH levels and then those >0.2g/L (6.25 mmol/L); (2) acidotic patients; (3) anyone needing haemodialysis.

from http://www-clinpharm.medschl.cam.ac.uk/pages/teaching/topics/poison/poison9.html

[Kenny Bunk]

Specific antidote is ethanol and this should be given IV as a 10% solution in 5% dextrose A loading dose of 0.6g/kg should be given followed by an lVI of 0.07g/kg/hr for non-drinkers (regular drinkers should receive 0. 16g/kg/hr)

It's called the "Mojito Protocol." And no, the Day Care Center people cannot read.

[agere_contra]

Thanks for the post. Interesting that the specific antidote is ethanol.