Toxic alcohols — fomepizole, ethanol and EXTRIP viva

Diagnosis frame. Parent toxic alcohols elevate the osmolar gap; metabolites (formate / glycolate–oxalate) drive HAGMA. Visual symptoms → methanol until proven otherwise; AKI, hypocalcaemia, oxalate crystals → ethylene glycol.^[1][2]

Antidote. Fomepizole first-line: 15 mg/kg IV load, then 10 mg/kg q12h ×4, then 15 mg/kg q12h; q4h on dialysis. Alternative IV ethanol to blood level 100–150 mg/dL if fomepizole unavailable.

Cofactors. Folinic acid for methanol; thiamine + pyridoxine for EG.^[3]

Dialysis. EXTRIP: coma, seizures, new vision deficits, pH at or below 7.15 or refractory acidosis, anion gap above 24, tiered methanol levels, or impaired kidneys — intermittent HD preferred; continue ADH blockade; watch rebound.^[3]