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To the Editor: In their Research Letter, Dr Blondell and colleagues¹ found that ethanol is still in the formularies of most US teaching hospitals. They suggest that ethanol is ineffective in treating alcohol withdrawal syndrome, and thus are concerned that having ethanol in a hospital formulary "may send the implicit message that alcohol is an appropriate remedy for illness."

In fact, recent practice guidelines cite ethanol as a treatment of methanol poisoning.² Older guidelines recognize ethanol as the traditional (but little-studied) therapy for ethylene glycol poisoning,³ and there have been case reports describing successful use of ethanol in less common intoxications.^4-5 Ethanol competitively inhibits the enzyme alcohol dehydrogenase from producing toxic metabolites of these various substances.

Another inhibitor of alcohol dehydrogenase, fomepizole, is available, but its use may be limited by hypersensitivity reactions.² Thus, there are reasons to keep ethanol in hospital formularies for the foreseeable future.

John G. Sotos, . . . [Full Text of this Article]

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