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In Reply: As Dr Sotos points out, intravenous (IV) ethanol may be an appropriate antidote for methanol and ethylene glycol poisoning. Although methanol and ethylene glycol themselves are not highly toxic, they are converted to metabolites that are (ie, formaldehyde and formic acid, or glycoaldehyde and glycolic acid, respectively). In addition to gastric decontamination, supportive care, and hemodialysis in selected patients, the treatment strategy for these poisonings is to block the initial step in their metabolism by inhibiting alcohol dehydrogenase, which converts the alcohol to an aldehyde.

Fomepizole is the only treatment approved by the US Food and Drug Administration (FDA) for methanol and ethylene glycol poisoning, and there is clinical evidence to support the recommendation that it should be the first-line treatment.^1-2 Traditionally, intoxicating IV doses of pharmaceutical-grade ethanol have been used as an alcohol dehydrogenase inhibitor, but the evidence to support this practice is limited.³ Currently, the only . . . [Full Text of this Article]

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Ethanol in Hospital Formularies
John G. Sotos
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