METHANOL & MUSHROOM INTOXICATION

Sri Sutarni

Sub Dep Neurotoxicology

Dept Neurology Fac. Of Med. GMU/ Sardjito Gen. Hospital
Yogyakarta
 Intoxication of Methanol & Mushroom increase time by time
 From Methanol Intoxication usually cause by Mixed with
other Solvent  potentiate Intoxication
 Mushroom Intoxication by eating and indigestion
 Methanol Intoxication also known as Wood Alcohol
 Commonly used as Organic Solvent  Toxic
 Metabolic Acidosis, Neurologic Sequele, even Death when
ingested
 Commercially Industrial Solvents
 Common Problems in many parts of Developing World:
member of lower Socioeconomy Classes
 Methanol has a Relatively low Toxicity
 The Adverse Effect from Accumulation of Formic Acid 
metabolite of Methanol Metabolism
 By Ingestion  Methanol quickly absorbed in the
Gastrointestinal Tract  Metabolized in the Lever 
Degradation of Methanol:
1 st Step : Formaldehyd by Alcohol Dehydrogenase Enzyme
(ADH)  slower
2nd Step : Formaldehyd  Formic Acid by Aldehyde
Dehydrogenase Enzyme

 Half Life of Formaldehyd estimated 1 – 2 minutes

 Formic Acid + O2  CO2 + H2O with Tetrahydrofolate
 Slow Metabolism of Formic Acid very Slow  Accumulates
in the Body  Metabolic Acidosis
 Early  Mild CNS Depression: Osmolar Gap & High Methanol Level
 Latent Period : 12 – 24 hours
 Late Period  CNS : Vertigo, Lethargy, Coma, Seizures, Parkinson Like
Syndrome, Putamen Necrosis & Hemorrhage
 Anion Gap Metabolic Acidosis due to Formate & Lactate, falling
Osmolar gap & Methanol Level
4. Eye Damage:  Interruption of Mitochondrial Functtion in the Optic Nerve 
Hyperaemia, Edema & Optic Nerve Atrophy
 Formic Acid Destruction of Myelin
 Optic Nerve Demyelination
 The major Damage at Retrolaminar Optic Nerve, Intra-Axonal Swelling &
Organelle Destruction
 The Retina  Little/ No Change
 Decrease Acuity, Photophobia, Pupillary defect, Hyperemia of Optic Disc, Retinal
Edema, Central Scotoma & Blindness
5.Gatrointestinal Tract  Abdominal Pain, Pancreatitis & Transaminitis
6. Kidney:  Acute Kidney Injury & Myoglobinuria (rare)
 Imaging Techniques to understand the Clinical Manifestation
 Neurologic Complication recognized more frequently
 Several ECG Changes, Sinus tachicardia & Non Specific T-wave
Changes  Severe Acidosis
 Funduscopic Changes notable a few hours after Methanol Ingestion
& Retinal edema in Perimacular region to Entire Fundus
 48 hours observed Optic edema & Hyperaemia
 Movement Disorders  Delayed several weeks after Exposure:
Tremor, Coghweel Rigidity, Stooped Posture, Shuffling Gait &
<kinesia
 Fomepizole/ Ethanol  reduce Alcohol Dehidrogenase (AD) on
Methanol by Competitive
 Inhibition: > Effectively Binding & saturating AD Enzyme in the Liver
 blocking the binding of Methanol  Excreted by the Kidney
without more Toxic Formaldehyd & Formic Acid
 AD converts Ethanol  Acetaldehyde: less toxic Organic Molecule
+ Sodium Bicarbonate for Metabolic Acidosis
 Hemodialysis & Visual Toxicity  S -formate levels >_ 3,7 mmol/L
 Hemodialisis / Hemodiafiltration: Remove Methanol & Formate from
the Blood
 Folinic acid/ Folic Acid: enhance the metabolism of Formate
 Prevented for Visual Injury by Antidote Tx/ Elimination from the System by
Hemodialysis
 Movement Disorders  Antiparkinson agents, Levodopa, Amantadine,
Bromocryptin

Complication
 Vision Loss  the mechanism of Methanol causes Toxicity to the Visual System is
not well understood  the Toxic Metabolite  Formic acid  responsible for
ocular Toxicity in
 Animal models & Human studies
 Serum Methanol levels > 20 mg/dL  Ocular injury
 Parkinsonian  Some long-term Survivers of Methanol Poisoning
 Formic Acid : predilection for accumulating in high concentration within the
Putamen : this phenomenon is unclear
 Formic Acid able to impaired Dopaminergic Pathways & Increase Enzymatic
Activity of Dopa-B-Hydroxylase
 Muscle Spasm: Poorly Respon to Traditional Tx
 S –Formate levels >_ 11-12 mmol/L  Visual/ CNS sequele & Lethal outcome
 >_ 17,5 mmol/L, S-lactate levels >_ 7.0 mmol/L &/or pH ,6,87  poor outcome >
90% Death/ Survive with sequelae
 Management Acid Base Disturbances
 Depend on the amount of Methanol Consumed, Subsequent Degree of Metabolic
Acidosis
 More Severe Acidosis  Poor Prognosis
 The Amount of accumulated Formic Acid in the Blood  Direct Correlation with
Morbidity & Mortality
 Little long term Improvement can be Expected in Patients with Neurologic
Complication
 nausea,
Irritan of 20 min – 4 hour
after ingesting vomiting,
Gastrointestinal
cramps, diare
 Normal condition:
 Fresh for 7 – 10 days, flavor , Vitamine D, Mineral, Proteine
 Hygiene, food safety, Prevent from Food borne illness
 Fresh / cooked : 7 – 10 days, sliced: 5 – 7 days, frozen 6 – 8 month
 Abnormal condition:  stiky / slimmy surface, darker color, quickly destroyers
 Poisons :  White gills, skirt/ ring on the stem & bulbus
 Milk cap & lactate
 Change of colour, when cut? Size, shape & texture
 Gastro intestinal symptom: Blood Diare, Vomitus, Abdominal
discomfort, Abdominal Cramp,
 Disturbance of Kidney & Lever, Clotting of the Blood
 Carcinogenic & Halucinogenic effect
 Rhabdomyolysis  Respiratory Disturbance, Myocarditis;
Inflammation of Myocard  Death
 Pain after 1 week eating Mushroom: Acronylic acid as
Neurotransmitter Glutamat
 Electrolyte Disturbance
 Replace food & Electrolyte correction
 After 6 – 24 hour digestion  Kidney & Lever still comfort
 More than 24 hour: Vomiting, Blood Diare, Abdominal Cramp 
better
 Anti Vomiting/ Gag reflex irritation, Stop Diare: give Relaxan,
Norite/ anti diare,Vitamine K, Muscle Relaxan
 Grade 4: Kidney & Lever relaps  Bleeding  disturbance of
Clotting factors
 Haloperidol for Halucinogenic condition, Anti Oxidant prevent
Carcinogenic agent
 The Prevalence of Methanol intoxication increase time by time
 Giving Education to the pasien, especially for Young Generation about the hazards of
Methanol Intoxication,
 How to Prevent from Methanol Intoxication, Irreversibel Side Effect especially to the
Eyes, Cognitif, Lever & Kidney Disturbance
 Management of Methanol Intoxication by giving Ethanol, Fomepizole, Hemodialisis to
the patients
 For Mushroom Intoxication: see the texture, Physically of mushroom, color, etc
 Halusinogenic, Cardiogenic, Carcinogenic effect must observed
 Replace the Mushroom from patients, Gastro intestinal symptom, Kidney, Lever, Clotting
time must detected
 Management for Mushroom Intoxication: Electrolyte correction, Symptomatic treatment