Fatal Methanol Intoxication – Two Exceptional Cases

Poisonings from toxic alcohols, such as methanol (MeOH) are a serious toxicological concern worldwide. In an endemic methanol poisoning in 2012 in the Czech Republic 121 subjects had consumed adulterated beverages and 41 died from the poisoning. An additional 20 subjects still suffer from visual/CNS sequelae [1]. In addition to mass poisonings single cases of methanol poisoning had been published recently [2-4]. Toxicity of methanol is related to the production of toxic metabolites by the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which can lead to metabolic acidosis, blindness and death. Therapy usually consists of general supportive care, hemodialysis and use of antidotes. While hemodialysis is still considered a key element in the treatment of methanol intoxication there are two antidotes available which allow to block ADH-mediated metabolism of methanol: ethanol and fomepizole [5-9]. In the following, two exceptional cases of methanol poisoning from routine work in the ZIFM (Zurich Institute of Forensic Medicine) are presented.