Treatment of a 1,4-butanediol poisoning with fomepizole.
BACKGROUND
Toxicity of 1,4-butanediol, an industrial solvent and a substance of abuse, is still misunderstood and not well documented. To date, only supportive treatments are used in this poisoning.


METHODS
The case of a 43-year-old man who ingested 30 mL of a homemade 1,4-butanediol solution and who developed general seizures and coma has been reported here. An intravenous loading dose of fomepizole 10 mg/kg was started on admission and followed by two other doses of 10 mg/kg every 12 hour. He awoke shortly after fomepizole administration. Initial plasma 1,4-butanediol and gamma-hydroxybutyric acid concentrations, measured by gas chromatography-mass spectrometry, were 24 and 222 mg/L, respectively. Subsequent 1,4-butanediol and gamma-hydroxybutyric acid determination suggest that there was some further formate of gamma-hydroxbutyric acid after fomepizole was administered.


CONCLUSIONS
Fomepizole administration appeared safe in this 1,4-butanediol-intoxicated patient. It is unknown whether fomepizole influenced his clinical course, but the rapid awakening observed suggests that it may have been usefuL Further experience is needed, however, to define the efficacy of this antidotal therapy in 1,4-butanediol intoxication.
Mégarbane
Bruno
B
Reanimation Médicale et Toxicologique, Université Paris VII, INSERM U26, Hôpital Laribosière, France. bruno-megarbane@wanadoo.fr
Fompeydie
Dominique
D
Garnier
Robert
R
Baud
Frédéric J
FJ
D000328:Adult; D000931:Antidotes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002072:Butylene Glycols / Q000097:blood / Q000506:poisoning*; D003128:Coma / Q000139:chemically induced; D000077604:Fomepizole; D006801:Humans; D006885:Hydroxybutyrates / Q000032:analysis / Q000378:metabolism; D007262:Infusions, Intravenous; D008297:Male; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012640:Seizures / Q000139:chemically induced; D012997:Solvents / Q000506:poisoning*; D019966:Substance-Related Disorders / Q000097:blood / Q000378:metabolism; D016896:Treatment Outcome
D000931:Antidotes; D002072:Butylene Glycols; D006885:Hydroxybutyrates; D011720:Pyrazoles; D012997:Solvents; C111420:4-hydroxybutyric acid; C039681:1,4-butanediol; D000077604:Fomepizole