Forgoing the Folate?-Contemporary Recommendations for Methanol Poisoning and Evidence Review

Methanol poisonings can produce significant toxicity in humans, including acidosis, blindness, and death. The current mainstay of therapy is alcohol dehydrogenase (ADH) inhibition to prevent formation of formic acid and hemodialysis to correct acidosis and remove both parent compound and toxic metabolite. Folate has been recommended as an adjunctive therapy to increase formic acid oxidation into carbon dioxide and water. We retrospectively reviewed recommendation of folate therapy for methanol poisoning by our regional poison center from 2002 to 2012. One hundred two patients met inclusion criteria. Our findings demonstrate a sharp decline in folate recommendation over the course of the study period (48% vs. 12% during the years 2002-2006 and 2007-2012, respectively), despite similar rates of ADH inhibition, hemodialysis, and serious outcomes. This may be related to the approval of the use of fomepizole in methanol poisoning in 2002, which provides a quicker, more reliable means of ADH inhibition than ethanol infusions. We also provide a review of the available evidence of folate use in methanol poisoning.