Approach to confirmed ethylene glycol or methanol poisoning

BUN: blood urea nitrogen; IV: intravenous; Na: sodium; PO: orally.

* Initial fomepizole dose is 15 mg/kg IV loading dose, followed by 10 mg/kg every 12 hours for 4 doses, then 15 mg/kg every 12 hours. If fomepizole is not available, can start ethanol IV or orally (refer to UpToDate content for instructions). If patient is requiring hemodialysis, refer to UpToDate content for increased fomepizole dosing frequency and ethanol infusion rate. If the patient has a serum ethanol concentration >100 mg/dL, fomepizole should be given once the serum ethanol decreases to approximately 100 mg/dL. Refer to UpToDate content on ethanol intoxication in adults for rate of ethanol elimination.

• If using mg/dL (conventional units) for glucose, BUN, ethanol: Osmolal gap = Measured osmolality – [(2 × Na) + glucose/18 + BUN/2.8 + ethanol/3.7]
• If using mmol/L (SI units) for glucose, BUN, ethanol: Osmolal gap = Measured osmolality – [(2 × Na) + glucose + BUN + (1.25 × ethanol)]

Δ Cofactor therapy (if unsure of which alcohol, can give cofactors for both):

• Methanol: leucovorin 50 mg IV or folic acid 50 mg IV every 6 hours
• Ethylene glycol: thiamine 100 mg IV once daily and pyridoxine 100 mg IV once daily

◊ Estimated ethylene glycol or methanol concentration:

• Estimated ethylene glycol concentration in mg/dL = Increase in osmolal gap × 6.2
• Estimated methanol concentration in mg/dL = Increase in osmolal gap × 3.2