1.
Resuscitation & stabilization
2. Gastric lavage: for 30-60 min of ingestion
( others : no alter outcome )
3. Activated charcoal: not useful
4. Three treatment goals:
a.
Correction of metabolic acidosis with bicarbonate
b. Alcohol dehydrogenase blockade
c. Removal by hemodialysis
A.
Correction of metabolic acidosis
IV
bicarbonate, intermittent bolus
( 1-2 meq/kg boluses and 150meq/L of D5W
at 1.5X to 2X the maintenance fluid rate)
B.
Alcohol dehydrogenase blockade
Ethanol
or fomepizole (4-MP or antizol)
Maintain ethanol level between 100-150 mg/dl
a. Ethanol:
1.Oral : recommend concentration: 20-30%, higher may
cause gastritis/ UGI bleedingLoading:0.6-0.8g/kg ,
maintain:0.11g/kg/hr
Formula : ethanol (g)= vol (ml) X 0.9 X (proof/200)
2. ( 國內無IV 的酒精, 用口服. 米酒(20%) –5ml/kg,紹興酒 (16%)– 7ml/kg
) loading,
3. IV of 10 % ethanol in D5W : Loading :7.6 –10 ml/kg
Maintain: 1.0-2.0 ml/kg/hr b.
Fomepizole ( 4MP)-
15mg/kg IV and
10 mg/kg Q12h X 4 then
15 mg/kg IV Q12h
until Methanol level < 20 mg/ dL
C.
Removal by hemodialysis
Other
treatment:
1.
Folinic acid (leucovorin): 50 mg IV
2. Thiamine 100mg IV Q6hrs
3. Pyridoxine 50 mg IV Q6hrs
Prognosis
1.Correlate with degree of acidosis/ time to presentation/
treatment within 8 hrs
2. Poor prognosis: Coma / seizures / pH < 7.0
3. Survival : Permanent blindness/ Parkinsonism/encephalopathy/
polyneuropathy/ cognitive
dysfunction/ transverse myelitis/ seizures
Pitfalls
1. An anion gap metabolic acidosis may not be apparent within
the first 8-12 hrs of acute poisoning
2. A normal osmolarity gap cannot exclude methanol poisoning
3. In late presentations, the osmolarity gap may be normal
while the anion gap is elevated
Discharge
Criteria
a. Asymptomatic
b. Normal electrolytes, Bun & Cr
c. Ethanol & methanol levels = Zero
d. Eight hrs of observation
e. Psychiatric evaluation
