Methodological instruction of the Ministry of Health of the Slovak Republic to treat person intoxicated with methanol
Methodological instruction
Ministry of Health of the Slovak Republic
to treat a person intoxicated with methanol
Date: 19.9.2012
Number: z44513-2012
Ministry of Health of the Slovak Republic pursuant to § 45 (1) (a). (b) Law No 576/2004 Coll. on health care, services related to the provision of healthcare and amending certain laws, as amended, gives this methodological instruction
Art. I
Subject of the methodological instruction
This methodological instruction regulates the procedure for providing healthcare to a person intoxicated with methanol.
Art. II
Diagnostics of the Intoxicated Person
Diagnostics shall detect anamnestic data related to alcohol consumption within the last 48 hours. The first signs of methanol intoxication are similar to those of normal alcohol poisoning (e.g. headache, weakness, restlessness, vertigo, nausea, vomiting, abdominal pain, Kussmaul breathing, formaldehyde odour, tachypnoea). After 8 to 30 hours latency, visual disturbances or blindness may occur. Severe methanol intoxications may develop convulsions and deep coma.
Art. III
Treatment of the intoxicated person
In the context of initiating treatment with an intoxicated person, consideration should be given to withdrawing the gastric contents with a nasogastric tube if the person is immediately after ingestion of methanol.
Ethanol treatment is initiated if the intoxicated person has symptoms typical of methanol intoxication and has:
- Methanol concentration in plasma > 20 mg/dl or > 200 mg/l, or
- a history of ingestion of a toxic methanol dose (more than 0,1 mg/kg) and osmolality > 10mOsm/l; or
- positive history or strong suspicion of methanol intoxication with at least two non-specific laboratory criteria of the following:
- pH of arterial blood < 7.3
- Serum bicarbonate < 20 mEq/l
- osmolality exceeding 10 mOsm/l above normal osmolality.
In exceptional cases, treatment with ethanol can be replaced with Fomepizole, with the National Toxicological Information Centre to be consulted in advance.
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 objective of the treatment is to achieve a serum alcohol concentration of 100 -150 mg/dl so that the serum alcohol level is maintained within 1-1.5‰ of alcohol, while monitoring the levels of alcohol and glucose in serum.
During haemodialysis, alcohol doses should be increased or alcohol added to the dialysis solution as methanol is also undergoing dialysis. During haemodialysis, a serum alcohol concentration of 100 mg/dl should be achieved.
Children
The initial and maintenance dose of alcohol is the same as for adults. Serum alcohol levels should be monitored at 1 hour intervals to achieve 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 so that the serum alcohol level in the adult person is maintained between 1-1⁄5 ‰ of serum alcohol under simultaneous monitoring of the 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 monitoring of glycaemic control 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. As indicated, consult an ophthalmologist, a nephrologist and a neurologist.
Indicating haemodialysis at blood methyl alcohol levels above 500 mg/l, while increasing ethanol doses to twice.
Art. VII
Consultation
The healthcare provider has the possibility, if necessary, to consult the procedure for providing healthcare in the framework of a 24-hour telephone service with the National Tox screen Centre University Hospital Bratislava, Limbová 5, telephone contact 02/54774166, mobile 0911 166 066.
Art. VIII
Reporting obligation
The healthcare provider shall report each case of a person intoxicated with methanol:
- Ministry of Health of the Slovak Republic,
- National Tox screen University Hospital Bratislava, Limbová 5, 24-hour telephone service, mobile 0911 166 066,
- The basic unit of the Slovak Police Department, 24 hour continuous telephone service
- the competent regional public health office.
Art. IX
Efficacy
This methodological instruction takes effect on 20 September 2012
Zuzana Zvolenská, v. r.
Minister