Treatment of a 1,4-Butanediol Poisoning with Fomepizole

Abstract

Background: Toxicity of 1,4-butanediol, an industrial solvent and a substance of abuse, is still misunderstood and not well documented. To date, only supportive treatments are used in this poisoning. Case Report: The case of a 43-year-old man who ingested 30 mL of a homemade 1,4-butanediol solution and who developed general seizures and coma has been reported here. An intravenous loading dose of fomepizole 10 mg/kg was started on admission and followed by two other doses of 10 mg/kg every 12 hour. He awoke shortly after fomepizole administration. Initial plasma 1,4-butanediol and γ-hydroxybutyric acid concentrations, measured by gas chromatography–mass spectrometry, were 24 and 222 mg/L, respectively. Subsequent 1,4-butanediol and γ-hydroxybutyric acid determination suggest that there was some further formate of γ-hydroxybutyric acid after fomepizole was administered. Conclusion: Fomepizole administration appeared safe in this 1,4-butanediol-intoxicated patient. It is unknown whether fomepizole influenced his clinical course, but the rapid awakening observed suggests that it may have been useful. Further experience is needed, however, to define the efficacy of this antidotal therapy in 1,4-butanediol intoxication.