title: Methanol poisoning: the duality between 'fast and cheap' and 'slow and expensive'.
abstract: The management of methanol poisoning includes early antidote therapy to inhibit the metabolism of methanol to formate. Ethanol and fomepizole are both effective, but recently fomepizole has been preferred, although there is no scientific evidence that the use of fomepizole is a superior therapeutic strategy compared with the use of ethanol combined with haemodialysis. The same patient was admitted twice to our emergency department with methanol poisoning. The first time (methanol 3.24 g/l), she was treated with fomepizole without dialysis owing to the absence of acidosis. The second time (methanol 5.5 g/l), she received ethanol as an antidote and dialysis was started. For both therapeutic strategies, hospital length of stay, observation unit length of stay and costs are compared. In the Belgian healthcare system, we found that fomepizole treatment was three times as expensive as ethanol treatment, and the majority of costs are not reimbursed. Fomepizole antidote therapy, compared with ethanol, has fewer reported side effects, but is more expensive. In hospitals where dialysis is easily available, ethanol antidote therapy should still be considered, especially if similar cost differences exist within the healthcare system one is working in.
authors.affiliation: Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: Anseeuw
authors.forename: Marc B
authors.initials: MB
authors.lastname: Sabbe
authors.forename: Annemie
authors.initials: A
authors.lastname: Legrand
mesh_terms: D000328:Adult; D000931:Antidotes / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001530:Belgium; D000431:Ethanol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D000077604:Fomepizole; D017721:Hospital Costs; D006801:Humans; D008658:Inactivation, Metabolic; D007902:Length of Stay / Q000191:economics; D000432:Methanol / Q000506:poisoning*; D011041:Poisoning / Q000191:economics / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011720:Pyrazoles / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006435:Renal Dialysis / Q000191:economics
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000432:Methanol