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Formate kinetics in methanol poisoning.

William Kerns1, Christian Tomaszewski, Kenneth McMartin

  • 1Emergency Medicine and Toxicology, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA. rkerns@carolinashealthcare.org

Journal of Toxicology. Clinical Toxicology
|July 20, 2002
PubMed
Summary

Dialysis effectively clears formate, a toxic methanol metabolite, but did not significantly speed up its natural removal in patients. High formate levels correlate with low pH, low bicarbonate, and increased anion gap.

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Area of Science:

  • Toxicology
  • Nephrology
  • Emergency Medicine

Background:

  • Methanol poisoning can lead to toxic metabolite accumulation, specifically formate.
  • Formate contributes to the acidemia and metabolic derangements seen in methanol toxicity.
  • Understanding formate kinetics is crucial for managing methanol poisoning.

Purpose of the Study:

  • To characterize the elimination kinetics of formate (FA) in methanol poisoning.
  • To determine the dialysis clearance rate of formate.
  • To identify laboratory markers associated with formate levels.

Main Methods:

  • Prospective, multicenter study involving patients with methanol poisoning treated with fomepizole and/or dialysis.
  • Serial plasma formate, methanol, pH, and electrolytes were measured.

Related Experiment Videos

  • Elimination half-lives and dialysis clearance were calculated; correlations with lab markers were analyzed.

    • Main Results:

    • Eight of eleven patients had detectable formate, with a mean level of 15.1 mmol/L.
    • Endogenous formate half-life was 205 minutes; during dialysis, it was 150 minutes (not significantly different).
    • Dialysis formate clearance was 223 mL/min; formate correlated strongly with low pH, low bicarbonate, and high anion gap.

    Conclusions:

    • Dialysis effectively removes formate from the blood.
    • Dialysis did not significantly accelerate the overall elimination of formate compared to endogenous clearance in this cohort.
    • Low pH, low serum bicarbonate, and elevated anion gap are independent indicators of formate presence in methanol poisoning.