3. MECHANISM OF ACTION
METHANOL FORMALDEHYDE FORMIC
ACID
ALDEHYDE DEHYDROGENASEALCOHOL DEHYDROGENASE
METHANOL ITSELF NOT TOXIC. FORMALDEHYDE VERY TOXIC, BUT VERY
RAPIDLY METABOLISED TO FORMIC ACID. FORMIC ACID RESPONSIBLE
FOR THE TOXICITY RELATED TO METHANOL INGESTIONS
4. MECHANISM OF ACTION
METHANOL
FORMALDEHYDE
FORMIC
ACID
ACIDOSIS
Early stage
of poisoning
ACIDOSIS
TISSUE
HYPOXIA
LACTIC ACID
PRODUCTION
CIRCULATORY
FAILURE
GENERAL TOXICITY
INCREASED FORMIC ACID TOXICITY
OCULAR
TOXICITY
INHIBITION OF MITOCHONDRIAL RESPIRATION
CIRCULUS
HYPOXICUS
5. SIGNS AND SYMPTOMS
In small doses Dizziness (vertigo)
Headache
Nausea & Vomitting
Abdominal pain
In Moderate doses Tachy cardia
Drowsiness
Mydriasis (dilation of the pupil)
In High doses Metabolic Acidosis
Convulsions
Retinal Oedema
COMA
Respiratory failure and death
6. SIGNS AND SYMPTOMS
CNS – CONVULSIONS, PROGRESSING TO COMA
RETINAL - BLURRED VISION, PHOTOPHOBIA, VISUAL
ACUITY LOSS, DILATED NON-REACTIVE PUPILS,
OPTIC NERVE BECOMES OEDEMATOUS
GIT - NAUSEA, VOMITING
CARDIAC - TACHYCARDIA, HYPERTENSION PROGRESSING
TO HYPOTENSION AND CARDIOGENIC SHOCK
RESPIRATORY - TACHYPNOEA
11. Name : Mr. X Age :58
Sex : Male DOA : 27/7/13
CHIEF COMPLAINTS :
C/O Right Shoulder pain in the morning following which he
faints and then goes into unconscious state
convulsions (before going unconscious) (tongue bite mark seen)
HISTORY OF PRESENT ILLNESS :
N/K/C/O – BA / HTN / Epilepsy
Consumption of high levels of alcohol (12 hrs ago)
PAST MEDICAL HISTORY :
Known Diabetic, wound present over the right foot for over 7 months
PERSONAL HISTORY/ SOCIAL HABITS
K/C/O Alcoholism – 25 yrs
Smoking – 14 yrs
12. PHYSICAL EXAMINATION :
Pt was Unconscious/ disoriented
ON EXAMINATION :
Temp : 103° F BP : 110 / 70
Pulse : 88 RR 16
SYSTEMIC EXAMINATION :
CVS: S1 S2 +ve CNS : pupils not responding (dilated)
Initially responded to painful stimuli
followed by no response
RS : NVBS P/A : Soft
14. OTHER TESTS :
CT - subcortical white matter and basal ganglia hyperintensity and low-signal-
intensity
ECG – Bradycardia
DIAGNOSIS
Alcohol Poisoning ( Methyl Alcohol)
15. TREATMENT
Initially - Stomach wash given, Commercially available Ethanol 10 %
soln (30 ml)
DRUGS DOSE R.O.A FREQ No of Days
Inj Fosolin (Fos Phenytoin)
(anti convulsant)
150 mg IV stat 1
Inj Ceftum (cefuroxime) 250 mg IV OD 1
Inj Pantocid (pantoprazole) 40 mg IV BD 1
Inj Strocit ( citicoline)
(a Neurotonics/Neurotrophics)
250 mg IV BD 1
Inj Lasix 20 mg IV Stat 1
Inj Sodium Bicarb 500 mL IV Stat 1
16. PROGNOSIS OF CASE
The Subject goes into irreversible COMA
Respiratory Depression occours ( put on mechanical ventilation)
Sudden Cardiac Failure
Death