Date: 19.9.2012
Number: z44513-2012

Ministry of Health of the Slovak Republic pursuant to § 45 (1) (a). (b) Act No 576/2004 Coll. on Health Care, Services related to health care provision and amendment Some laws, as amended, issue this methodological instruction

Art. I
Subject of the methodological instruction

This methodological instruction governs the healthcare procedure a person intoxicated with methanol.

Art. II
Diagnostics of the Intoxicated Person

Diagnostics detect anamnestic consumption-related data alcohol within the last 48 hours. First signs of methanol intoxication are similar to normal alcohol poisoning (e.g. headache, weakness, restlessness, vertigo, nausea, vomiting, abdominal pain, Kussmaul breathing formaldehyde odour, tachypnoea). After latency 8 to 30 hours, visual disturbances or blindness. For severe intoxications spasms and deep coma may develop with methanol.

Art. III
Treatment of the intoxicated person

In the context of initiating treatment with an intoxicated person, suction should be considered. nasogastric tube, if person immediately after ingestion of methanol.

Ethanol treatment should be initiated if the intoxicated person has symptoms typical of methanol intoxication and has:

  1. Methanol concentration in plasma > 20 mg/dl or > 200 mg/l, or

  2. history of ingestion of the toxic methanol dose (more than 0.1 mg/kg) and osmolality > 10mOsm/l or

  3. positive history or strong suspicion of methanol intoxication; at least two non-specific laboratory criteria must be present the following:

  4. pH of arterial blood < 7.3
  5. Serum bicarbonate < 20 mEq/l
  6. osmolality exceeding 10 mOsm/l above normal osmolality.

Treatment with ethanol may in exceptional cases be substituted with Fomepizole, and its administration should be consulted in advance with the National Toxicological the information centre.

Art. IV
Dosing 40% alcohol per axis or nasogastric tube

Adults
Initial dose of alcohol: 2 ml/kg (approximately 125-175 ml 40% alcohol e.g. Geneva, vodka, gin, whisky).
Maintenance dose of alcohol: 0.2 - 0.35 ml/kg/h.

The aim of the treatment is to achieve a serum alcohol concentration of 100 -150 mg/dl, to maintain a serum alcohol level of between 1 and 1,5‰ of alcohol for monitoring of serum alcohol and glucose levels.
During haemodialysis, alcohol doses should be increased or alcohol added to dialysis solution because, like methanol, it undergoes dialysis. During haemodialysis should achieve a serum alcohol concentration of 100 mg/dl.

Children
The initial and maintenance dose of alcohol is the same as for adults. Is monitoring serum alcohol levels at 1 hour intervals, so to reach the target serum alcohol concentration of 100 mg/dl.

Art. V
Dosage of ethanol administered intravenously

Administer an intravenous glucose solution of 5% with 10% ethanol to make up serum alcohol in the adult person maintained in the range of 1-1,5 ‰ alcohol in monitoring of serum alcohol and glucose levels.

Initial ethanol dose: 0.8 g/kg, i.e. 8 ml/kg 10% ethanol.
Maintenance dose of ethanol:
Abstinent: 80-130 mg/kg/hour, i.e. 0.8 – 1.3 ml/kg/hour
average consumer: 140mg/kg/hour, i.e. 1.4 ml/kg/hour
chronic consumer: 150 mg/kg/hour, i.e. 1,5ml/kg/hour.
Frequent glycaemic monitoring is recommended during ethanol therapy in children, as ethanol-induced hypoglycaemia is frequent in children.

Art. VI

Folic acid should be administered every 4 hours to prevent visual impairment. (the recommended dose is 50 mg intravenous or per axis).
Control essential vital functions. Consult if indicated an ophthalmologist, a nephrologist and a neurologist.

Indicate haemodialysis at blood methyl alcohol levels above 500 mg/l and at the same time increase ethanol doses to double.

Art. VII
Consultation

The healthcare provider shall have the option, where appropriate Consultation of the healthcare process within 24 hour continuous telephone service with National Toxicological Information Centre University Hospital Bratislava, Limbová 5, telephone Contact 02/54774166, Mobile 0911 166 066.

Art. VIII
Reporting obligation

The healthcare provider is obliged to report each case to the person intoxicated with methanol:

  1. Ministry of Health of the Slovak Republic,

Art. IX
Efficacy

This methodological instruction takes effect on 20 September 2012

Zuzana Zvolenská, v. r.
Minister