Methanol

Methanol or isopropanol is usually not detectable in blood or other body fluids. These alcohols are sometimes found in postmortem specimens as a contaminant of embalming fluid and the embalming process. Methanol, sometimes referred to as wood alcohol, is often used as a solvent in cleaning products, paint stripper, industrial solvents, and as a component of canned fuel. Methanol is slowly metabolized by the liver at approximately one-tenth the rate of ethanol. Approximately 90-95% of methanol is metabolized in the liver and 5-10% is excreted unchanged through the lungs and kidneys.

Methanol itself is relatively nontoxic; however, it is metabolized to compounds that result in acidosis, blindness, and possibly death. In 2002, there were 2610 reported methanol exposures, with 18 fatalities (2). The lethal dose of methanol has been estimated to be 1-2mL/kg (3). Methanol is metabolized by ADH to formaldehyde, and the formaldehyde is further metabolized to formic acid by aldehyde dehydro-genase. Formic acid is responsible for the profound anion gap metabolic acidosis and ocular toxicity that develops. Serum formate concentrations correlate more closely with the severity of acidosis and ocular toxicity compared with serum methanol concentrations. Therefore, measurement of formate to assess toxicity is preferable. Historically, treatment of methanol poisoning, as well as ethylene glycol poisoning, was accomplished through administration of ethanol. Ethanol competes with methanol for metabolism by ADH. More recent treatment modalities utilize 4-methylpyrazole (4-MP), which is a competitive inhibitor of ADH that blocks the metabolism of methanol to its active metabolite. Hemodialysis may also be required to remove formate that has already accumulated before initiation of treatment.

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