Methanol and formate kinetics in late diagnosed methanol intoxication.

In a 21-year-old subject, methanol intoxication was undiagnosed for 12 hours after admission. Only bicarbonate treatment was given during this period, although treatment later included ethanol and haemodialysis. The maximal blood methanol and formate levels were 143 (44.7) and 54.3 mg/dl (11.8 mmol/L), respectively. The delayed diagnosis uniquely allowed for an estimate of methanol elimination kinetics. Before specific treatment, methanol elimination was of zero-order, with a rate of 8.5 mg/dl/h. After admission, the formate levels remained relatively constant until blood pH was normalised by bicarbonate treatment. From this point the formate levels declined, despite an unchanged methanol elimination, indicating that the formate was eliminated faster than it was formed from methanol. Thus, formate elimination may be pH-dependent and aggressive treatment of the acidosis may increase this elimination.