Methyl Alcohol Poisoning: Management Tips

Successful management of methyl alcohol poisoning requires prompt recognition. The most important therapeutic action is to correct the metabolic acidosis quickly. Methyl alcohol or methanol is an industrial solvent and widely used as paint thinner, paint remover, nail-polish remover and as a denaturant in ethyl alcohol. The poisoning due to methyl alcohol occurs due to consumption of rectified spirit or methylated spirit or illicit distilled ethyl alcohol. Methanol is completely absorbed within 3-4 hours of ingestion. After absorption the methanol is metabolized in the liver by the action of alcohol dehydrogenase to form formaldehyde and formic acid. Some of the ingested methanol is eliminated unchanged by the kidneys and lungs.

Ingestion of more than 30 ml of methanol/methyl alcohol is lethal, but the extent of toxicity may be influenced by concomitant ingestion of ethyl alcohol and other unknown host factors. A blood level of methanol of 20mg/dl is toxic. Severity of toxicity correlates with the level of methanol in blood. The variability in the development of methanol toxicity may be due to various liver diseases and availability and synthesis of alcohol dehydrogenase.

Symptoms of methanol poisoning after illicit alcohol consumption:

A person suspected of having consumed pure methanol or rectified spirit, industrial solvent/thinner, nail-polish remover or illicit distilled alcohol may complain of abdominal discomfort and pain, breathlessness, cardiac arrhythmia and blurred vision. If medical help is delayed the patient may go blind with delayed onset of coma.

Tips to manage methanol poisoning:

If the patient is not unconscious, try to know the type of alcoholic drink he/she has consumed. The patient should be shifted to emergency wing of a nearby hospital immediately. If the patient has consumed pure methanol, he/she should be encouraged to take around 4 oz of brandy or whisky to retard the metabolism as the enzyme alcohol dehydrogenase has more affinity for ethyl alcohol than the methyl alcohol. An assay of methanol blood levels can help to confirm the diagnosis, however, a patient having consumed a doubtful solvent and having metabolic acidosis and burred vision, should be considered a case of methanol poisoning and treated accordingly. Liver function tests along with blood pH and urine analysis should be done. The patient should be put on hemodialysis or promptly referred to a hospital where facilities for hemodialysis are available. Any arrhythmia, heart failure, convulsions or shock need urgent medical attention. If more than 4 hours have elapsed since ingestion and patient do not have arrhythmia and blurred vision, gastric lavage should be performed with sodium bicarbonate solution until the return fluid is clear of methanol. Patient should be kept under observation till considerable metabolic recovery.