Two cases of acute methanol poisoning partially treated by oral 4-methylpyrazole

Objective: Since the use of 4-methylpyrazole (4-MP) in the treatment of hum ans with methanol poisoning is poorly documented, we report two cases of ac ute methanol intoxication partially treated by this potent alcohol dehydrog enase (ADH) inhibitor. Setting: Intensive Care Unit in a university hospital. Patients: A 56-year-old man and an 18-year-old woman were observed, respect ively, 41 and 16 h after the voluntary ingestion of an unknown amount of me thanol, Intervention: In both cases, ethanol was used as the first antidote. In the first patient, hemodialysis was also performed on admission because a high methanol level (0.72 g/l) and visual impairment were noted. In the second patient, ethanol therapy was withdrawn after 12 h when clinical and biologi cal signs of acute pancreatitis became evident. Both patients received mult iple oral doses of 4-MP. No recurrence of metabolic acidosis occurred and t he 4-MP therapy was well tolerated, Conclusion: While the use of 4-MP is better documented in cases of ethylene glycol poisoning, it could also become an accepted option for the manageme nt of methanol poisoning since 4-MP offers advantages over ethanol therapy.