Methanol intoxication: clinical features and differential diagnosis

Methanol intoxication causes severe metabolic acidosis and can lead to permanent visual damage or death. Methanol, readily available in common products like antifreeze, is ingested accidentally or deliberately as a substitute for ethanol and in suicide attempts. Because it may become a major fuel source in the 21st century and because industrial uses are expanding, deliberate and accidental intoxication is likely to increase. Rapid diagnosis is essential so that appropriate treatment can be instituted quickly. The authors review the pharmacology, clinical and laboratory findings, and pathology and pathophysiology of methanol intoxication. In addition, they discuss the differential diagnosis and treatment of acute intoxication, including the use of 4-methylpyrazole in preventing the conversion of methanol to formate.