Patient handout

Toxic alcohols (methanol / ethylene glycol)

PRODUCTION

1. Your condition

This handout is for toxic alcohols (methanol / ethylene glycol). Your care team identified this based on: reported ingestion of methanol (windshield wash, bootleg ethanol) or ethylene glycol (antifreeze) (aact 2023).

Other reasons your team may use this plan: unexplained hagma (extrip 2015); osmolar gap >10 (or >25 highly suspicious) (extrip 2015); methanol vision changes / eg flank pain + oliguria (extrip 2015).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
fomepizole	15 mg/kg IV over 30 min	IV	load (single)	Brent NEJM 2001 (Methylpyrazole for Toxic Alcohols Study Group) — fomepizole is preferred over ethanol drip (no CNS depression, no infusion adjustment, no ICU bed requirement)

Plan: Methanol / Ethylene glycol — fomepizole-first antidote ladder + cofactors + HD (AACT 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Osmolar gap >25 mOsm/kg with HAGMA, not explained by ethanol/mannitol/glycerol [EXTRIP 2015]
Methanol level >50 mg/dL OR ethylene glycol level >50 mg/dL [EXTRIP 2015](life-threatening)
Arterial pH <7.3 in toxic alcohol context [EXTRIP 2015](life-threatening)
Acute kidney injury (creatinine rise) OR oliguria in toxic alcohol context [EXTRIP 2015]
Methanol ingestion + new visual symptoms (blurred vision, snowfield blindness, optic disk edema) [EXTRIP 2015](life-threatening)
Fomepizole unavailable, contraindicated, or patient cannot tolerate [EXTRIP 2015]

5. Follow-up

Ophthalmology for methanol survivors (EXTRIP 2015); nephrology if AKI/HD; psych safety plan; PCP med review

6. Sources

Guideline: Pending — manifest is scaffold-level. Anchors: 2015 EXTRIP toxic alcohols (Roberts et al, Crit Care Med); AACT/EAPCCT methanol + EG position papers; ACMT clinical pathway