title: Methanol Kinetics in Chronic Kidney Disease After Fomepizole: A Case Report.
abstract: Methanol is a common toxicant in the United States, especially from automotive products. Its kinetics have been described previously and typically involve little urinary excretion. We present a case of prolonged methanol half-life in a patient with chronic kidney disease. An 80-year-old male with a baseline glomerular filtration rate of 24 mL·min·1.73 m was transferred to our facility after unintentional methanol ingestion. The original facility had treated him with an oral ethanol load; upon arrival to our facility, he was immediately loaded with fomepizole. His initial serum methanol concentration was 66.1 mg/dL. After a risk/benefit discussion, we decided not to perform hemodialysis on the patient and he was treated with fomepizole and supportive care. After 6 days as an inpatient, the patient's methanol level had declined to 22 mg/dL, fomepizole was discontinued, and the patient was able to be discharged without apparent complications. Based on the exponential best fit line for the patient's methanol concentrations, his methanol half-life during fomepizole treatment was approximately 70 hours, significantly longer than the 30-50 hours typically reported. The reasons for this difference are unclear. This report is limited by being a single case. Further study on the kinetics of methanol in the setting of chronic kidney disease is needed.
authors.affiliation: 1Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA; and 2Division of Toxicology, Virginia Commonwealth University Health System, Richmond, VA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Maskell
authors.forename: Sara
authors.initials: S
authors.lastname: Beckett
authors.forename: Kirk L
authors.initials: KL
authors.lastname: Cumpston
mesh_terms: D000369:Aged, 80 and over; D000931:Antidotes / Q000627:therapeutic use*; D000077604:Fomepizole; D006207:Half-Life; D006801:Humans; D008297:Male; D000432:Methanol / Q000493:pharmacokinetics* / Q000506:poisoning; D011041:Poisoning / Q000150:complications / Q000188:drug therapy*; D011720:Pyrazoles / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism*; D012997:Solvents / Q000493:pharmacokinetics* / Q000506:poisoning
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D012997:Solvents; D000077604:Fomepizole; D000432:Methanol