Abstract
Objectives. The optimal antidote for the treatment of ethylene glycol or methanol intoxication is not known. The objective of this systematic review is to describe all available data on the use of ethanol and fomepizole for methanol and ethylene glycol intoxication. Data Source. A systematic search of MEDLINE and EMBASE was conducted. Study Selection. Published studies involving the use of ethanol or fomepizole, or both, in adults who presented within 72 hours of toxic alcohol ingestion were included. Our search yielded a total of 145 studies for our analysis. There were no randomized controlled trials, and no head-to-head trials. Data Extraction. Variables were evaluated for all publications by one independent author using a standardized data collection form. Data Synthesis. 897 patients with toxic alcohol ingestion were identified. 720 (80.3%) were treated with ethanol (505 Me, 215 EG), 146 (16.3%) with fomepizole (81 Me, 65 EG), and 33 (3.7%) with both antidotes (18 Me, 15 EG). Mortality in patients treated with ethanol was 21.8% for Me and 18.1% for EG. In those administered fomepizole, mortality was 17.1% for Me and 4.1% for EG. Adverse events were uncommon. Conclusion. The data supporting the use of one antidote is inconclusive. Further investigation is warranted.
Highlights
Toxic alcohol poisonings with methanol or ethylene glycol have the potential to cause signi cant morbidity and mortality
Methanol and ethylene glycol are relatively common and potentially fatal toxic alcohol ingestions. Both alcohols are metabolized in the liver by the enzyme alcohol dehydrogenase (ADH) to produce toxic metabolites which are responsible for an anion-gap metabolic acidosis, and other adverse effects
It is metabolized to formic acid which can cause neurologic injury, optic nerve toxicity, and retinal injury resulting in vision impairment [151–153]
Summary
Toxic alcohol poisonings with methanol or ethylene glycol have the potential to cause signi cant morbidity and mortality. In 2009, poison centers in the United States (US) received 8139 reports of toxic alcohol ingestion of which 29 died, and 259 had a major outcome (de ned as life threatening, or resulting in signi cant residual disability) [1] Both methanol (Me) and ethylene glycol (EG) are metabolized by the liver enzyme alcohol dehydrogenase (ADH) to toxic metabolites, which cause a profound metabolic acidosis, along with other serious toxic effects. Poison control data from 2000 indicate that fomepizole was used in only 167 poisonings, while ethanol use was reported 305 times [2] Despite this change in the management of patients with toxic alcohol ingestion, there has been no direct comparison of ethanol and fomepizole, in terms of efficacy, safety, or cost-effectiveness to provide evidence that one antidote is superior to the other. Despite this change in the management of patients with toxic alcohol ingestion, there has been no direct comparison of ethanol and fomepizole, in terms of efficacy, safety, or cost-effectiveness to provide evidence that one antidote is superior to the other. e objective of this paper is to perform a systematic review of the literature to describe the efficacy and safety of ethanol
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