Norwegian doctor brings hope - and antidote - to methanol poison victims

The Czech health ministry says there have been no new deaths in the last 24 hours from the outbreak of methanol poisoning, and attention is now shifting to the 27 people still in hospital. Help has arrived in the form of an effective but expensive antidote called fomepizole, eighty boxes of which have donated by Norway. They were brought here by poisons expert Dr Knut Erik Hovda from the Nuclear, Biological and Chemical Centre in Oslo. Radio Prague spoke to Dr Hovda shortly before he went into a meeting at Ostrava Hospital, and we began by asking him how common methanol poisoning was.

Dr. Knut Erik Hovda,  source:
“It’s fairly infrequent. In most parts of the western world, it’s fairly infrequent. It happens from time to time, but it’s usually only attempted suicides or suicides or accidents, or it’s outbreaks like this one happening right now in the Czech Republic. We did have a similar one in Norway, back in 2002.”

And were there fatalities in that outbreak?

“Yeah, we had 18 fatalities that we know of. But we’re pretty sure there were patients who were admitted to hospital and never got the diagnosis. They got different diagnoses. Then we had the families come into the hospitals later on and it appeared they’d been drinking the same liquor. But we know of 18 fatalities.”

That’s strikingly similar to the current situation in the Czech Republic. Tell me about this antidote that you’ve brought with you from Norway.

“Yeah, fomepizole. It’s a highly specific antidote that’s been used for quite a few years actually. It’s similar to ethanol in that it blocks the same enzyme, but it binds much more efficiently, and even more so, it’s easier to dose. It avoids many of the side effects of ethanol such as patients being drunk, and they don’t get as depressed.”

And you can administer the antidote when the patient’s unconscious, is that right?

“Yes. Actually you can even give it orally, you can let the patient drink it, for instance if it’s a child. But you usually would give it intravenously, and it can be given to all kinds of patients even after they’ve started receiving the ethanol infusion as an antidote.”

So you say the antidote stops the methanol from being broken down by the digestive system...

“From being metabolised, yes.”

But how then does the methanol leave the body?

“Humans eliminate ethanol primarily through breath and partly through their urine. But our clinical practice would be using dialysis to clean the blood. Then we would remove both the methanol and the toxic metabolite - the formic acid, and we would also correct the metabolic acidosis, which is a threat to the patient.”

Photo: CTK
And how effective is fomepizole?

“It’s highly effective. It binds extremely strongly to the enzyme, meaning if you are admitted early enough to hospital, we’re pretty sure we can save your life. The problem being that a lot of these patients are admitted fairly late. It depends on their clinical condition when they’re admitted to hospital; that tells us something about the outcome of the patient. But the fomepizole itself is highly efficient.”

So it is really a glimmer of hope for those suffering from methanol poisoning.

“Yeah, for sure. Like I said, as long as they’re admitted early enough, it’s definitely a glimmer of hope. Now we’re trying to organise some nationwide lectures for [Czech] doctors, who are doing a fabulous job by the way, and teaching them a little bit about fomepizole and what we consider the best techniques or treatment options.”