Methanol toxicity secondary to inhalant abuse in adult men

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 47; no. 3; pp. 239 - 242
• Main Authors: Wallace, Erik A., Green, Adam S.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Informa UK Ltd 01-03-2009; Taylor & Francis
• Subjects: Acidosis - chemically induced; Addictive behaviors; Adult; Adult and adolescent clinical studies; Antidotes - therapeutic use; Biological and medical sciences; Carburetor; Drug addiction; Drug addictions; Ethanol - blood; Ethanol - therapeutic use; Ethnic Groups; European Continental Ancestry Group; Hispanic Americans; Humans; Indians, North American; Inhalant abuse; Male; Medical sciences; Methanol - blood; Methanol - poisoning; Methanol toxicity; Middle Aged; Native American; Oklahoma - epidemiology; Poisoning - blood; Poisoning - diagnosis; Poisoning - epidemiology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pyrazoles - therapeutic use; Renal Dialysis; Solvents - poisoning; Substance-Related Disorders - blood; Toxicology; Vision Disorders - chemically induced; Young Adult; United States; North America; America; Oklahoma; Human; Amerindian; Drug addiction; Secondary; Inhalant abuse; Toxicity; Male; Ethnic group; Methanol toxicity; Inhalation; Carburetor; Race; Cleaning materials; Adult; Methanol; Native American
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650802498781

Background. The purpose of this report is to evaluate the presentation, treatment, and outcomes of adults with methanol toxicity from inhalation of carburetor cleaning fluid fumes. Methods. Retrospective chart review of adults with positive serum volatile screen for methanol and history of carburetor cleaning fluid fume inhalation. Results. Sixteen patients were admitted 68 times. Eleven Native American patients accounted for 90% of admissions. Sixty-five cases presented with nausea vomiting; 27 with intoxication or altered mental status; 21 with specific visual complaints. About 93% had a pH <7.35, 96% had serum bicarbonate <20 mEq L, 81% had osmolal gap ≥10 mOsm L, and 69% had anion gap >16. Ten had an initial serum methanol level <20 mg dL, 29 cases 20-49 mg dL, 19 cases ≥50 mg dL. Six patients had a measurable serum ethanol level. Of the 29 patients with a methanol level of 20-49 mg dL, 20 received intravenous antidote (ethanol or fomepizole); three received an antidote and hemodialysis. All who presented with a serum methanol level ≥50 mg dL received intravenous ethanol or fomepizole. All visual symptoms resolved before discharge and all patients survived without sequelae. Discussion. This is the largest reported number of cases of methanol toxicity from the inhalation of carburetor cleaning fluid fumes and demonstrates a problem with recurrent abuse among some older Native American men. Conclusion. Intentional inhalation of methanol fumes may produce toxicity. Clinicians need to question patients, especially older Native American men, regarding the possible inhalation of carburetor cleaning fluid fumes in those who present with an unexplained metabolic anion gap acidosis.