As the metabolites are responsible for the toxicity, competitive inhibitors of alcohol dehydrogenase should be considered for severe cases of acute ingestion of glycol ethers. If they are to be used they should be administered as soon as possible, because metabolites are usually detectable in the urine very quickly after ingestion of glycol ethers. Ethanol is readily available and been used in a number of cases (Nitter-Hauge, 1970; Litovitz et al., 1991; Bauer et al., 1992; Gualtieri et al., 1995; Wermuth and Furbee, 1997; Nisse et al., 1998; McKinney et al., 2000). Fomepizole is an alternative competitive inhibitor which may be used. There is only limited experience with its use in glycol ether poisoning (Nisse et al., 1998). It is newer, less readily available and expensive. However, ethanol therapy usually necessitates intensive care facilities because a high blood ethanol concentration (which must be regularly monitored) is required and this results in CNS depression. Fomepizole has the advantage of not producing CNS depression and has few side effects; intensive care facilities are therefore not required.
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