MECHANISM OF ACTION

ALCOHOL DEHYDROGENASE ALDEHYDE DEHYDROGENASE

METHANOL FORMALDEHYDE FORMIC

ACID

METHANOL ITSELF NOT TOXIC. FORMALDEHYDE VERY TOXIC, BUT VERY

RAPIDLY METABOLISED TO FORMIC ACID. FORMIC ACID RESPONSIBLE
FOR THE TOXICITY RELATED TO METHANOL INGESTIONS
 MECHANISM OF ACTION
METHANOL

OCULAR FORMALDEHYDE
TOXICITY
INHIBITION OF MITOCHONDRIAL RESPIRATION

INCREASED FORMIC ACID TOXICITY FORMIC

ACID
CIRCULATORY
FAILURE

TISSUE CIRCULUS
ACIDOSIS ACIDOSIS
HYPOXIA HYPOXICUS

LACTIC ACID
PRODUCTION Early stage
of poisoning
GENERAL TOXICITY
 SIGNS AND SYMPTOMS
In small doses  Dizziness (vertigo)
 Headache
 Nausea & Vomitting
 Abdominal pain

In Moderate doses Tachy cardia

 Drowsiness
 Mydriasis (dilation of the pupil)

In High doses  Metabolic Acidosis

 Convulsions
 Retinal Oedema
 COMA
 Respiratory failure and death
 SIGNS AND SYMPTOMS
CNS – CONVULSIONS, PROGRESSING TO COMA

RETINAL - BLURRED VISION, PHOTOPHOBIA, VISUAL

ACUITY LOSS, DILATED NON-REACTIVE PUPILS,
OPTIC NERVE BECOMES OEDEMATOUS

GIT - NAUSEA, VOMITING

CARDIAC - TACHYCARDIA, HYPERTENSION PROGRESSING

TO HYPOTENSION AND CARDIOGENIC SHOCK

RESPIRATORY - TACHYPNOEA
 INVESTIGATION

BLOOD METHANOL LEVEL (by titration method)

ABG

Fundoscopy ( to examine retinal

Image reference  http://www.meajo.org/article.asp?issn=0974-
9233;year=2013;volume=20;issue=1;spage=92;epage=94;aulast=Iscan
 TREATMENT
(i) ABC

(ii) CORRECTION OF METABOLIC ACIDOSIS

BICARBONATE (AGGRESSIVE TREATMENT)

(iii) Ethanol ( competitive binding to ADH)

(iv) Haemodialysis

(v) Folinic acid (elemination of formic acid)

(vi) Fomepizole
CASE STUDY
Name : Mr. X Age :58
Sex : Male DOA : 27/7/13

CHIEF COMPLAINTS :

C/O Right Shoulder pain in the morning  following which he

faints and then goes into unconscious state
 convulsions (before going unconscious) (tongue bite mark seen)

HISTORY OF PRESENT ILLNESS :

N/K/C/O – BA / HTN / Epilepsy

Consumption of high levels of alcohol (12 hrs ago)

PAST MEDICAL HISTORY :

Known Diabetic, wound present over the right foot for over 7 months

PERSONAL HISTORY/ SOCIAL HABITS

K/C/O Alcoholism – 25 yrs

Smoking – 14 yrs
PHYSICAL EXAMINATION :

Pt was Unconscious/ disoriented

ON EXAMINATION :
Temp : 103° F BP : 110 / 70
Pulse : 88 RR 16

SYSTEMIC EXAMINATION :

CVS: S1 S2 +ve CNS : pupils not responding (dilated)

Initially responded to painful stimuli
followed by no response

RS : NVBS P/A : Soft

Pt. Name is hidden

Metabolic
acidosis
OTHER TESTS :

CT - subcortical white matter and basal ganglia hyperintensity and low-signal-

intensity

ECG – Bradycardia

DIAGNOSIS

Alcohol Poisoning ( Methyl Alcohol)

 TREATMENT

Initially - Stomach wash given, Commercially available Ethanol 10 %

soln (30 ml)

DRUGS DOSE R.O.A FREQ No of Days

Inj Fosolin (Fos Phenytoin) 150 mg IV stat 1

(anti convulsant)

Inj Ceftum (cefuroxime) 250 mg IV OD 1

Inj Pantocid (pantoprazole) 40 mg IV BD 1

Inj Strocit ( citicoline) 250 mg IV BD 1

(a Neurotonics/Neurotrophics)

Inj Lasix 20 mg IV Stat 1

Inj Sodium Bicarb 500 mL IV Stat 1

PROGNOSIS OF CASE

The Subject goes into irreversible COMA

Respiratory Depression occours ( put on mechanical ventilation)

 Sudden Cardiac Failure

 Death   