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Management of Methanol and Ethylene Glycol Poisoning

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Methanol and ethylene glycol poisoning cause toxic adverse effects on the body. This article explains the management of methanol and ethylene glycol poisoning.

Written byDr. Sameeha M S

Medically reviewed byDr. Achanta Krishna Swaroop

Published At November 21, 2022
Reviewed AtNovember 17, 2025

Introduction

Accidental ingestion of ethylene glycol and methanol can cause serious conditions like brain injury, renal dysfunction, and blindness and may also result in death. Even a very low concentration of ethylene glycol and methanol can cause toxic effects in the body. Methanol and ethylene glycol poisoning may occur as a result of a suicidal attempt or due to accidental drinking. Symptoms like vomiting, loss of consciousness, poor coordination, and seizures may develop within a few hours. Early identification of alcohol poisoning and timely, effective treatment can reduce the severity of the poisoning.

What Is Methanol and Ethylene Glycol Poisoning?

Methanol (methyl alcohol) is a light, flammable, colorless, volatile liquid with an alcohol smell similar to that of ethanol. Methanol poisoning can occur due to accidental drinking, suicidal attempts, and drinking water used for cleaning windshields in vehicles (windshield water). After reaching the body, methanol is converted into formate, formaldehyde, and formic acid. These compounds produced as a byproduct of methanol breakdown will cause toxicity and health effects. Toxicity can affect most organs and, if untreated, will lead to death. Early identification and medical management can reduce the impact and death.

Ethylene glycol is a colorless, odorless,sweet-tasting liquid mainly used for the manufacture of polyester fibers and antifreeze formulations (to reduce the freezing point of liquids). Poisoning can occur due to a suicidal attempt or due to accidental drinking. Ethylene glycol can cause severe toxic effects even in very low concentrations. After reaching the body, it is metabolized to oxalic acid and glycolic acid. Toxicity will cause the deposition of calcium oxalate crystals in the urine and eventually leads to kidney failure.

What Are the Symptoms of Methanol and Ethanol Glycol Poisoning?

Initial Symptoms- Initial symptoms of methanol poisoning develop within a few hours. It includes:

  • Central nervous system depression.

  • Unconsciousness.

  • Lack of coordination.

  • Pain and gastric irritation

  • Headache.

  • Confusion.

  • Dizziness.

Late Symptoms - It occurs after 10 to 30 hours of poisoning. It includes:

  • Blurring or complete vision loss.

  • Retinal edema.

  • Tachypnea.

  • Brain hemorrhage (putaminal hemorrhage).

  • Hyperemia.

  • Cardiac failure.

  • Renal failure.

  • Cerebral edema.

  • Respiratory failure and death.

Symptoms of ethylene glycol poisoning are divided into three stages based on the time of onset and severity. It includes:

  • Stage 1 - It develops within 30 minutes to 12 hours after ingestion and consists of gastrointestinal and neurological symptoms. Nausea, stomach irritation, vomiting, confusion, headache, abnormal eye movements, lack of muscle coordination, excessive urination, and thirst are the common features of this stage.

  • Stage 2 - After initial symptoms, intense internal damage develops after 12 to 36 hours. These symptoms occur as a result of the toxic effects of ethylene glycol metabolites formed in the body. It consists of dehydration, hyperventilation, high blood pressure, heart rate, muscle spasms, and congestive heart failure.

  • Stage 3 - It occurs within 36 to 72 hours. Kidney failure occurs as a result of the toxic effects of ethylene glycol. Depression, coma, seizure, loss of appetite, presence of protein and blood cells in the urine, increased blood levels of potassium, and acute kidney failure are the advanced symptoms of ethylene glycol poisoning.

What Are the Diagnostic Tests Used for Methanol and Ethylene Glycol Poisoning?

Diagnostic tests used to identify the presence of methanol and ethylene glycol in the body includes the following:

  • Osmolal gap.

  • Lactate gap.

  • Anion gap.

  • Gas chromatography.

  • Urine examination for calcium oxalate crystals.

  • Calcium levels.

What Are the Treatment Options for Methanol and Ethylene Glycol Poisoning?

  • Stabilization - Initial treatment for methanol and ethylene glycol poisoning is stabilization. It primarily involves airway management. Airway management will help to relieve and prevent respiratory obstruction.

  • Decontamination - It can be used when the patient is admitted to the hospital shortly after the poisoning. Methanol and ethylene glycol are rapidly absorbed in the body, and hence gastrointestinal washing is not effective. Gastric contents can be aspirated using a nasogastric (NG) tube if the patient is presented to the hospital immediately after poisoning.

  • Alcohol Dehydrogenase Blockade - Adverse health effects after methanol and ethylene glycol poisoning occur due to the formation of toxic metabolites. Alcohol dehydrogenase enzyme (ALDH) present in the liver converts methanol to formaldehyde and formic acid (formate). Formic acid causes hypoxia, an imbalance in the acid-base balance (metabolic acidosis), and metabolic disturbances. After reaching the cells, ethylene glycol molecules are converted to oxalic acid and glycolic acid. Oxalic acid will cause nephrotoxicity and kidney damage. Fomepizole (4 methyl pyrazole) can be used for the treatment of methanol and ethylene glycol poisoning. This drug reduces the formation of toxic metabolites like formaldehyde and formic acid from methanol and oxalic acid and glycolic acid from ethylene glycol. It is achieved by the competitive inhibition of the alcohol dehydrogenase enzyme. Thus methanol and ethylene glycol is excreted in the urine in a less toxic form.

  • Use of Ethanol - Ethanol is used in conditions when fomepizole is not available. Ethanol has a very high affinity for alcohol dehydrogenase enzyme (ALDH) and thus prevents the conversion of methanol and ethylene glycol to toxic metabolites.

  • Hemodialysis - It can be done to increase the elimination of methanol, ethylene glycol, and its metabolites from the body. It is done in cases of acute kidney failure, metabolic acidosis, and severe electrolyte imbalance.

  • Fluids and Electrolytes - Sodium bicarbonate is used to treat metabolic acidosis and electrolyte imbalance.

  • Folinic Acid (Leucovorin) - It is used to reduce toxicity by increasing the metabolism of formic acid, which is formed from methanol.

  • Thiamine (Vitamin B1) and Pyridoxine (Vitamin B6) - These vitamins will help to increase the metabolism of toxic byproducts to less toxic compounds and their excretion in urine.

Conclusion

Accidental ingestion of methanol and ethylene glycol will cause serious health conditions. Toxic metabolites released from these alcohols will cause damage to tissues and organs. Safety measures must be followed to prevent accidental drinking and toxicity. Early identification of poisoning and immediate medical management can reduce the impact of toxicity and save lives.

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Frequently Asked Questions

Methanol exposure can be extremely dangerous, with significant mortality and morbidity if left untreated. It is often caused by accidental or intentional ingestions, accidental poisonings due to distilling and fermenting errors, and beverage contamination.

Methanol is extremely poisonous to humans. As little as two tablespoons can be deadly to a child, while about two to eight ounces can be deadly for an adult. Blindness is common and often permanent despite intense medical care.

Methanol ingestion leads to mild photophobia, blurred, misty vision, and marked reduced visual captivity to complete blindness. It generally takes around 18 to 48 hours to blind a person completely.

Methanol ingestion can lead to blindness and severe other consequences. It is sufficient to produce acute destruction of parts of the central nervous system, leading to permanent neurological dysfunction and irreversible blindness. Methanol poisoning is an irreversible process.

Methanol ingestion initially leads to drowsiness, reduced level of consciousness, headache, depression, confusion, dizziness, and inability to coordinate muscle movement.

To remove methanol, administration of ethanol or Fomepizole, both inhibitors of enzyme alcohol dehydrogenase, to prevent the formation of the metabolites, and hemodialysis to remove ethanol and formate.

An overdose of ethylene glycol can damage the liver, brain, lungs, and kidneys. The poisoning leads to disturbances in the body’s chemistry, which includes metabolic acidosis. These can lead to severe consequences like organ failure, shock, and death.

Reports state ingestion of ethylene glycol with a volume of 150-1500 ml consumed at one time can be fatal to humans. The lethal dose of ethylene glycol is estimated at 1400-1600 mg/kg.

As little as 120 milliliters or approx 4 fluid ounces of ethylene glycol is enough to make an individual sick. This can lead to severe enough profound organ failure, shock, and death.

Fomepizole, an alcohol dehydrogenase enzyme, is an antidote for both methanol and ethylene glycol poisoning.

The best treatment for ethylene glycol poisoning is hemodialysis and inhibition of alcohol dehydrogenase. The target plasma ethanol concentration is 100 to 125 mg per deciliter.

The best antidote for methanol positioning is Fomepizole. Ethanol is used if this is not available. Hemodialysis can also be used in individuals where there is organ damage or a high degree of acidosis.

The three stages of ethylene glycol poisoning are stage 1, which occurs within 30 minutes to 12 hours after ingestion, and stage 2, which occurs between 12 to 24 hours after ingestion. Stage 3 occurs between 24 to 72 hours after ingestion.

Initial effects of ethylene glycol poisoning are intoxication, euphoria, stupor, central nervous system depression, respiratory depression, nausea, and vomiting.

No, reversing methanol blindness is not possible. The damage caused by methanol poisoning can lead to permanent damage to visual activity and cause permanent blindness.

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Dr. Achanta Krishna Swaroop from iCliniq
Dr. Achanta Krishna Swaroop

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