Fomepizole (4-Methylpyrazole) in Fatal Methanol Poisoning with Early CT Scan Cerebral Lesions

Abstract

Background: Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis.Case Report: We report a case of fatal methanol poisoning (1.9g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. Conclusion: The fomepizole treatment protocol (10 mg/kg by IV infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.