title: Fomepizole (4-methylpyrazole) in fatal methanol poisoning with early CT scan cerebral lesions.
abstract: BACKGROUND
  Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis.
  
  
  METHODS
  We report a case of fatal methanol poisoning (1.9 g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia.
  
  
  CONCLUSIONS
  The fomepizole treatment protocol (10 mg/kg by i.v. infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.
authors.affiliation: Service de Reánimation Medicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, Rouen, France. christophegirault@chu.rouen.fr
authors.forename: C
authors.initials: C
authors.lastname: Girault
authors.forename: F
authors.initials: F
authors.lastname: Tamion
authors.forename: F
authors.initials: F
authors.lastname: Moritz
authors.forename: F
authors.initials: F
authors.lastname: Callonnec
authors.forename: J M
authors.initials: JM
authors.lastname: Droy
authors.forename: G
authors.initials: G
authors.lastname: Bonmarchand
authors.forename: J
authors.initials: J
authors.lastname: Leroy
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000188:drug therapy; D000328:Adult; D000426:Alcohol Dehydrogenase / Q000037:antagonists & inhibitors; D000931:Antidotes / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects; D003128:Coma / Q000139:chemically induced / Q000188:drug therapy; D003956:Dialysis; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D000077604:Fomepizole; D006801:Humans; D000432:Methanol / Q000493:pharmacokinetics / Q000506:poisoning*; D011720:Pyrazoles / Q000627:therapeutic use*; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed
chemical_list: D000931:Antidotes; D004791:Enzyme Inhibitors; D011720:Pyrazoles; D000077604:Fomepizole; D000426:Alcohol Dehydrogenase; D000432:Methanol