Oral ethanol doses in patients with methanol poisoning

The dose of oral ethanol required to maintain a therapeutic blood ethanol concentration in the treatment of methanol poisoning was compared to the predicted dose based on ethaqol elimination data. Using pharmacokinetic equations and serial blood ethanol determinations, ethanol therapy was used to treat five patients with acute methanol poisoning. The goal of therapy wasa blood ethanol concentration between 100 and 200 mg/dl. Ethanol was administered hourly by nasogastric tube; doses were increased empirically until optimal blood levels were obtained. Blood methanol concentrations upon hospital admission ranged from 27 to 425 mg/dl (mean = 190 mg/dl). Hemodialysis was performed on all but one patient. Predicted oral ethanol doses that would attain a blood concentration of 100 mg/dl were: 0.6 g/kg for a loading dose, and maintenance doses Of 237 mg/kg/hr during hemodialysis and 109 mg/kg/hr at other times. The loading doses were generally adequate; four patients had a blood ethanol concentration above 100 mg/dl, and the fifth patient's concentration was 90 mg/dl. Maintenance doses had to be increased to maintain blood ethanol in the therapeutic range. During hemodialysis, patients required 255-633 mg/kg/hr ethanol; at other times, 109-150 mg/kg/hr ethanol was needed. One patient, who had a history of ethanol abuse and who had been given activated charcoal orally, required much larger doses than the other patients. It is concluded that the therapeutic ethanol regimen for treating methanol ingestion should be: an oral loading dose of 0.6-0.8 g/kg and maintenance doses of 250-350 mg/kg/hr during hemodialysis and 110-130 mg/kg/hr when patients are not being hemodialyzed. Doses should be individualized based on measured blood ethanol concentrations.