Noah Vinter
Methanol, also known as wood alcohol, is a highly toxic substance that is often ingested accidentally or as a cheap substitute for ethanol. The toxicity of methanol is due to its metabolite byproducts, including formaldehyde and formic acid, which are produced when methanol is metabolized in the liver. These toxic metabolites can cause severe metabolic acidosis, blindness, and even death. Methanol poisoning has led to numerous fatalities worldwide, including in Russia, Laos, India, and the United States.
| Characteristics | Values |
|---|---|
| Name | Methanol |
| Other Names | Wood alcohol, methyl alcohol, carbinol |
| Toxicity | Low |
| Toxicity of Metabolites | High |
| Metabolites | Formaldehyde, formic acid |
| Metabolism | Metabolised into formaldehyde by the enzyme alcohol dehydrogenase, which is then converted into formic acid |
| Treatment | Fomepizole, ethanol, sodium bicarbonate, hemodialysis, hemodiafiltration |
| Symptoms | Blurred vision, blindness, vomiting, abdominal pain, decreased consciousness, poor coordination, abdominal pain, decreased vision, metabolic acidosis, optic nerve necrosis, demyelination, coma, death |
| Occurrence | Found in industrial solvents, alcoholic beverages, perfumes, paint solvents, photocopying fluid, windshield washing fluid, antifreeze, canned solid fuel, body lotion, hand sanitiser |
| Notable Incidents | 2012 Czech mass poisoning, 2016 Irkutsk poisoning, 2020 Iranian methanol poisoning, 2024 Laos poisoning |
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What You'll Learn
Methanol is metabolised into formaldehyde and formic acid
Methanol, also known as wood alcohol, is a highly toxic organic solvent. It is dangerous to humans and can cause metabolic acidosis, neurologic sequelae, and even death when ingested. Methanol is quickly absorbed in the gastrointestinal tract and metabolised in the liver.
The first step in the metabolic pathway is the oxidation of methanol to formaldehyde (FA). This process is catalysed by the enzyme alcohol dehydrogenase (ADH). Formaldehyde levels in the body gradually increase, beginning around three hours after methanol ingestion.
The second step is the oxidation of formaldehyde to formic acid. This conversion is catalysed by a glutathione-dependent formaldehyde dehydrogenase specific for FA. Another formaldehyde dehydrogenase, NAD-dependent, catalyses this conversion in human erythrocytes. The third step is the oxidation of formic acid to carbon dioxide, catalysed by the 10-formyl-THF dehydrogenase enzyme.
Formaldehyde and formic acid are toxic metabolites responsible for the symptoms of methanol poisoning. These symptoms include an altered or decreased level of consciousness, poor or no coordination, vomiting, abdominal pain, and a specific smell on the breath. Blurred vision, leading to permanent bilateral blindness, is also characteristic of methanol poisoning. The accumulation of formic acid results in severe metabolic acidosis, which can rapidly lead to a coma and death.
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Methanol poisoning symptoms
Methanol, also known as wood alcohol, is a commonly used organic solvent. It is toxic and can cause metabolic acidosis, neurologic sequelae, and even death when ingested.
The toxicity of methanol occurs through two mechanisms. Firstly, methanol can be fatal due to its CNS depressant properties, similar to ethanol poisoning. Secondly, it is metabolized to form toxic byproducts such as formaldehyde, formic acid, and formate, which are responsible for much of the toxicity. These metabolites cause various metabolic disturbances, including inhibiting mitochondrial cytochrome c oxidase, resulting in hypoxia at the cellular level and metabolic acidosis.
Methanol poisoning can occur through ingestion, inhalation, or absorption through the skin. It is commonly found in antifreeze, perfumes, paint solvents, photocopying fluid, windshield washing fluid, and some alcoholic beverages. Unintentional methanol poisoning is particularly prevalent among children, individuals with alcoholism, and populations in developing countries.
Treatment for methanol poisoning includes administering sodium bicarbonate to reverse acidosis, and in more severe cases, dialysis may be required. Ethanol is also given intravenously to slow the production of toxic metabolites, allowing unchanged methanol to be excreted in the urine.
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Treatment for methanol poisoning
Methanol, also known as wood alcohol, is a toxic alcohol commonly used as an organic solvent. It is extremely dangerous and can be fatal when ingested, inhaled, or absorbed through the skin. The treatment for methanol poisoning involves the use of inhibitors such as fomepizole or ethanol, which competitively inhibit the action of alcohol dehydrogenase on methanol, preventing the formation of toxic metabolites like formaldehyde and formic acid.
Fomepizole is the preferred inhibitor, but ethanol, the active ingredient in alcoholic beverages, can be used if fomepizole is not available. Ethanol acts as a competitive inhibitor by binding to and saturating the alcohol dehydrogenase enzyme in the liver, blocking methanol from binding. This allows the body to excrete methanol without it being converted into toxic metabolites.
Additional treatments for methanol poisoning include the administration of sodium bicarbonate to treat metabolic acidosis, and hemodialysis or hemodiafiltration to remove methanol and formate from the blood. Folinic acid or folic acid may also be given to enhance the metabolism of formate.
The early recognition of methanol poisoning is crucial due to the nonspecific nature of many of its symptoms. Methanol poisoning can cause an altered or decreased level of consciousness, poor coordination, vomiting, abdominal pain, and a specific smell on the breath. Decreased vision may occur as early as 12 hours after exposure, and blindness may result from ingesting as little as 10 mL of methanol. Death may occur from ingesting quantities over 15 mL, with a median lethal dose of about 100 mL.
Methanol poisoning is often due to accidental ingestion, especially in children who may drink windshield washer fluid, or in adults who consume adulterated alcoholic beverages. It is also a risk for persons with alcoholism who may ingest methanol as a substitute for ethanol, and for persons working in poorly ventilated areas with methanol-containing products. Unfortunately, intentional ingestion of methanol has also occurred, with some reports of it being consumed in the belief that it could help treat COVID-19.
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How methanol poisons the body
Methanol, also known as wood alcohol, is a colourless, flammable liquid with a distinctive odour similar to ethanol. It is a toxic alcohol commonly used as an organic solvent and found in various household and industrial agents. Ingesting as little as 10ml of pure methanol can produce enough formic acid to cause permanent blindness and kidney failure, while consuming 15ml or more can be fatal.
Methanol poisoning is characteristically caused by ingestion, but it can also occur through inhalation or skin absorption. It is rapidly absorbed in the gastrointestinal tract and metabolised in the liver. In the first step of degradation, methanol is transformed into formaldehyde via the enzyme alcohol dehydrogenase (ADH). Formaldehyde is then converted to formic acid via aldehyde dehydrogenase. Formic acid is responsible for the toxic effects of methanol poisoning, causing metabolic acidosis and damage to multiple organ systems, particularly the central nervous system and the retina.
The symptoms of methanol poisoning include an altered or decreased level of consciousness, poor or no coordination, vomiting, abdominal pain, and a specific smell on the breath. Decreased vision may occur as early as twelve hours after exposure. Permanent bilateral blindness and kidney failure are possible long-term outcomes.
Treatment for methanol poisoning includes the administration of fomepizole or ethanol to reduce the action of alcohol dehydrogenase on methanol. Ethanol acts as a competitive inhibitor by binding to the enzyme more effectively, thereby blocking the conversion of methanol to toxic metabolites. Sodium bicarbonate may also be given to treat metabolic acidosis, and dialysis may be required in severe cases to remove methanol and formate from the blood.
Methanol poisoning is a significant concern, with accidental or intentional ingestion being the most common cause. It is often found in improperly distilled alcoholic beverages, particularly in developing countries, where it is consumed as a cheap substitute for ethanol. It is also present in various household and industrial products, such as windshield washer fluid, antifreeze, perfumes, paint solvents, and photocopying fluid.
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Methanol poisoning cases
Methanol, also known as wood alcohol, is a commonly used organic solvent that can cause metabolic acidosis, neurologic sequelae, and even death when ingested. It is a constituent of many commercially available industrial solvents and of poorly adulterated alcoholic beverages.
Czech Republic, 2012
A study of 38 patients from a methanol mass poisoning incident in the Czech Republic in 2012 found that S-formate levels ≥ 3.7 mmol/L led to the first clinical signs of visual toxicity. S-formate ≥ 11–12 mmol/L was associated with visual/CNS sequelae and a lethal outcome.
Irkutsk, Russia, 2016
In December 2016, 78 people died in Irkutsk, Russia, from methanol poisoning after ingesting a counterfeit body lotion that was primarily methanol rather than ethanol. The victims had been using the lotion as a cheap substitute for vodka, despite warnings on the bottle that it was not safe for drinking.
Laos, 2024
In November 2024, six foreign tourists died of suspected methanol poisoning after consuming contaminated alcohol at a hostel in Vang Vieng, Laos. The incident also hospitalized several others and had a significant impact on Laos's tourism-dependent economy.
Jordan, 2025
In June 2025, nine people died in various parts of Jordan from methanol poisoning after consuming alcohol contaminated with methanol produced by a local factory. 47 other people were hospitalized due to the poisoning. 12 people were charged with manslaughter, and 13 others were charged with complicity in attempted murder.
India
Recurring illicit alcohol poisoning incidents in India, known as "hooch tragedies," have exposed issues of poverty, corruption, and regulatory failure. Bootleggers prey on vulnerable communities by selling cheap, toxic alcohol containing methanol, causing avoidable loss of life.
Treatment
The treatment for methanol poisoning is sodium bicarbonate, which is given to reverse the acidosis. In more serious cases, dialysis may be required, and ethanol may be given intravenously to slow the production of toxic metabolites.
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Frequently asked questions
Methanol, also known as wood alcohol, is a commonly used organic solvent. It is toxic and can cause metabolic acidosis, neurologic sequelae, and even death when ingested.
Symptoms of methanol poisoning may include an altered/decreased level of consciousness, poor or no coordination, vomiting, abdominal pain, and a specific smell on the breath. Decreased vision may start as early as 12 hours after exposure.
Treatments for methanol poisoning include fomepizole or ethanol, which act to reduce the action of alcohol dehydrogenase on methanol. Additional treatments may include sodium bicarbonate for metabolic acidosis and hemodialysis to remove methanol and formate from the blood.
There have been several instances of methanol poisoning around the world. In 2016, 78 people in Russia died after ingesting counterfeit body lotion that contained methanol. During the COVID-19 pandemic, nearly 300 people in Iran died after drinking methanol under the false belief that it could treat the disease.
The main metabolite of methanol that is responsible for its toxicity is formic acid. Formic acid causes metabolic acidosis, which can lead to coma and death.
