Hemodialysis treatment of methanol intoxication

Hemodialysis was undertaken to treat methanol intoxication in a patient with intravascular hemolysis, myoglobinuria, systemic acidosis, renal insufficiency, retinal abnormalities, and a blood methanol level of 400 mg/dl, 29 h after methanol ingestion. Sixteen hours of treatment were required to achieve safe blood levels. Calculated methanol removal was 218 g, or 73% of the ingested dose, and extraordinarily large volumes of ethanol were required to maintain blood levels greater than 100 mg/dl. All the manifestations of methanol poisoning were reversed and there were no permanent sequelae. It is concluded that, if methanol levels remain high, even significantly delayed institution of hemodialysis can be beneficial. The treatment may need to be quite prolonged, and the amount of ethanol administered should be individualized according to the patient's blood levels.