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Methanol Poisoning — RACP Adult Medicine MCQ

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HardEmergency MedicineMethanol PoisoningRACP Adult Medicine

A 32-year-old man presents after intentional ingestion of 200 mL of methanol (windscreen washer fluid) 6 hours ago. He complains of visual blurring. His pH is 7.10 and osmolal gap is 45 mOsm/kg. What are the two critical treatments?

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Correct answer: A — Fomepizole (or IV ethanol) and urgent haemodialysis

Methanol poisoning requires two key interventions: (1) Fomepizole (competitive alcohol dehydrogenase inhibitor – prevents metabolism of methanol to toxic formic acid) or IV ethanol if fomepizole is unavailable; (2) Urgent haemodialysis to remove methanol and formic acid, correct acidosis, and prevent end-organ damage. Visual symptoms indicate optic nerve toxicity from formic acid. Folinic acid is adjunctive (enhances formic acid metabolism).

Reference: eTG – 2025 – Toxicology; Austin Health Toxicology – 2024 – Toxic Alcohol Protocol