Fomepizole (4-methylpyrazole) in fatal methanol poisoning with early CT scan cerebral lesions

Background: Methanol poisoning, potentially fatal, is generally treated wit h the combination of ethanol as antidote, and hemodialysis. Fomepizole, a c ompetitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowle dge, its use has never been reported as an antidote in severe methanol pois oning requiring hemodialysis. Case Report: We report a case of fatal methan ol poisoning (1.9 g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. Conclusion: The f omepizole treatment protocol (10 mg/kg by IV infusion over 1 hour before di alysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dial ysis) was simple to use and appeared effective in eliminating methanol in c ombination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomograph y (CT) scan.