Methanol Toxicity: An Emergency Department and Toxicologist Dilemma – Methanol Case Series, Investigation of Medical Professionals’ Knowledge, and Review of The Literature

Methanol is a clear, colorless, highly toxic alcohol widely used as paint, varnish removers, automotiveradiators, and washer fluid. Methanol intoxication incidence can be due to accidental, occupational,suicidal exposure or following an adulterated liquor’s ingestion. Methanol is not toxic itself but will bemetabolized to the exceedingly poisonous formaldehyde and formic acid. Methanol ingestion ends inwide anion-gap metabolic acidosis and devastating neurological complications, including drowsinessto coma and devastating intracranial hemorrhages. Severe toxicities can occur with an intake of 0.25ml/kg of 100% methanol. The blood level of methanol above 25 mg/dl is considered highly toxic.Methanol reaches its peak plasma levels within an hour. Treatment guidelines include antidotal therapy,hemodialysis, and metabolic acidosis correction. Due to methanol’s poisoning severity and graveoutcome of the affected cases, we had to present 4 case series for methanol intoxication, each with itsclinical manifestations and laboratory findings, to enlighten the medical practitioners about possiblecauses, presentations, and treatment modalities of such severe toxicity.Four methanol poisoning case series with different presentations were discussed in the current work.A questionnaire about methanol poisoning awareness was distributed through the ER physicians’ andnurses’ mail to investigate their ability to diagnose and treat methanol poisoning cases.More training of ER medical staff on toxicological presentations is highly recommended. Clinical andanalytical toxicologists should have a more prominent role in the management of such cases. Morelight and international publicity should be shed upon the methanol toxicity outbreaks encounteredglobally, with frequently updating the diagnostic and therapeutic guidelines following an evidencebasedapproach are highly recommended.