Timothy D. Collins

Methanol and Formate Kinetics in Late Diagnosed Methanol Intoxication

SummaryIn 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.

Role of ethanol metabolism in the alcohol-induced increase in urinary folate excretion in rats

Chronic ethanol use can lead to folic acid deficiency in humans. In rats, acute doses of ethanol produce a marked increase in the urinary excretion of folate which is followed by a decrease in plasma folate levels. To assess the respective roles of ethanol and its metabolism in these effects, five groups of male Sprague-Dawley rats were treated orally as follows: (1) ethanol in four doses of 1 g/kg each at 0, 1, 2 and 3 hr; (2) ethanol as above plus the alcohol dehydrogenase inhibitor 4-methylpyrazole (4-MP) at 50 mg/kg, i.p., 15 min prior to 0 hr; (3) glucose in four isocaloric doses; (4) glucose plus 4-MP as above; and (5) methanol in four doses of 1 g/kg. Total folate levels in the urine peaked in both ethanol- and methanol-treated rats at the same time as the urine alcohol levels (after 6-8 hr) and then declined over the same time course as the alcohol levels. Concurrent administration of 4-MP inhibited the metabolism of ethanol and maintained the increase in urinary folate excretion throughout 24 hr. Ethanol administration produced minor changes in the relative distribution of folate derivatives in the urine, and these changes were not prevented by 4-MP treatment. The urinary levels of formic acid, which is metabolized by folate-dependent processes, were increased by ethanol administration; this increase was prevented by 4-MP. These results suggest that ethanol is not unique among alcohols in increasing urinary folate excretion and that ethanol metabolism plays no role in the increased urinary folate excretion. However, ethanol metabolism contributes to a second effect of ethanol on the folate system, which leads to increased urinary levels of formic acid.

High Pressure Liquid Chromatographic Assay of 4-Methylpyrazole. Measurements of Plasma and Urine Levels

4-Methylpyrazole (4-MP), a potent competitive inhibitor of alcohol dehydrogenase activity, has potential usefulness as a treatment means for methanol and ethylene glycol poisoning as well as severe disulfiram-ethanol interactions. Further study of the safety and metabolism of 4-MP in human subjects is needed before it can be used in such therapies. An HPLC assay has been developed to measure 4-MP levels in plasma and urine samples. The method was sensitive enough to quantitate 4-MP in an amount as low as 0.1 nmol. Recovery of 4-MP from spiked urine and plasma samples was greater than 90%. 4-MP levels in the plasma and urine of rats injected with an oral dose of 50 mg/kg of body weight were determined; the detectability limit in these samples was about 3 microM. The method is easy to perform and thus has practical application for research laboratories dealing with ethanol metabolism and clinical laboratories desiring to monitor 4-MP levels.

DISTRIBUTION OF ORAL 4-METHYLPYRAZOLE IN THE RAT: INHIBITION OF ELIMINATION BY ETHANOL

4-Methylpyrazole (4-MP), a potent competitive inhibitor of alcohol dehydrogenase activity, is being studied as a therapeutic agent for methanol and ethylene glycol poisoning. In order to evaluate the distribution of 4-MP using doses in the potentially therapeutic range, male Sprague-Dawley rats were administered 4-MP orally at zero time in doses of 5, 10, or 20 mg/kg. Half of the rats were also treated orally at 0, 1, 2, and 3 h with ethanol (1 g/kg each h) and half with glucose in isocaloric amounts. At doses of 10 and 20 mg/kg, 4-MP elimination appeared to be saturated, with an elimination rate of 10 mumol/L/h. Elimination at 5 mg/kg was non-conclusive as to the order. The rate of 4-MP elimination was decreased about 50% by concomitant administration of ethanol. Urinary excretion of unchanged 4-MP accounted for only about 1% of the dose; the amount excreted unchanged was significantly increased by ethanol administration. The results demonstrate the mutual inhibition of metabolism by ethanol and 4-methylpyrazole, which may explain why the inhibition of ADH by 4-MP can be longer than that predicted by the elimination rate of 4-MP alone.

Acute Ethanol Ingestion by Humans and Subacute Treatment of Rats Increase Urinary Folate Excretion

Previous studies with rats showed that acute treatment with ethanol (4 g/kg) produce a marked increase in urinary folate levels, followed by a decrease in plasma folate levels. Analogous studies with human volunteer subjects using a lower dose of ethanol showed that there were small, but statistically significant increases in urinary folate levels after four hours. The initial ethanol dose was 1.0 g/kg with a single supplement of 0.1-0.2 g/kg to maintain ethanol blood levels at about 100 mg/dl for six hours. Further studies with rats were designed to test the cumulative effects of repeated daily doses of ethanol. Male Sprague-Dawley rats were treated for 1, 2, 3, or 4 days either with ethanol orally in 4 doses of 1 g/kg each at 0, 1, 2, and 3 hours or with glucose orally in 4 isocaloric doses. Urine was collected at timed intervals up to 12 hours after each daily dose. The pattern of the increase in urinary folate levels was similar in all groups, whether treated for 1, 2, 3 or 4 days. These results suggest that repeated ethanol treatment can lead to a marked cumulative folate loss via increased urinary excretion and that increased urinary folate excretion may contribute to the development of folate deficiency in humans.

Effect of ethanol consumption during pregnancy on folate coenzyme distribution in fetal, maternal, and placental tissues

Abstract Ethanol has been shown to be a teratogen in humans and experimental animals; however, the mechanism of its actions is not known. Because ethanol interferes with the metabolism of folate coenzymes that participate in various biosynthetic pathways of nucleic acids, the effect of gestational ethanol consumption on the distribution of folate coenzymes in tissues was investigated with an eye to the possibility that such effects might shed light on the mechanism by which ethanol produces its teratogenic effect. Sprague-Dawley rats were fed a 35% ethanol-calorie liquid diet from gestation days 7–21; controls were pair-fed with isocaloric sucrose substituted for ethanol. Rats were killed on day 21. Food intake, maternal weight gain, litter size, and conceptus weight were similar between ethanol and control rats. However, fetal weight was decreased and placental weight increased in ethanol group as compared with the control. Total folates and folate coenzymes were determined in fetal liver and brain, placenta, and maternal liver. Ethanol consumption decreased 5-methyltetrahydrofolate in the placenta, which was compensated by increasing tetrahydrofolate and formyltetrahydrofolates. In fetal liver, formyltetrahydrofolates and formiminotetrahydrofolate were decreased and tetrahydrofolate increased with ethanol. In fetal brain, ethanol not only decreased total folates but also altered the coenzyme pattern by decreasing 5-methyltetrahydrofolate and increasing tetrahydrofolate and formyltetrahydrofolates. These changes in folate coenzyme pattern indicate ethanol-induced alteration in folate metabolism. The possible physiologic significance of these changes in relation to Fetal Alcohol Syndrome is discussed.

Relationship of alcohol metabolism to folate deficiency produced by ethanol in the rat

Chronic ethanol use can lead to folic acid deficiency in humans. In rats, acute doses of ethanol produce a marked increase in urinary folate excretion, which precedes a decrease in plasma folate levels. To assess the role of ethanol and its metabolism in these effects, five groups of male Sprague-Dawley rats were treated orally as follows: (1) ethanol in 4 doses of 1 g/kg each at 0, 1, 2 and 3 hr; (2) ethanol, as above, plus the alcohol dehydrogenase inhibitor 4-methylpyrazole (4-MP) at 50 mg/kg IP 15 min prior to 0 hr; (3) glucose in 4 isocaloric doses; (4) glucose plus 4-MP as above; (5) methanol in 4 doses of 1 g/kg. Urinary folate levels (by Lactobacillus casei assay) peaked in both ethanol- and methanol-treated rats at the same time as the urine alcohol levels (6-8 hr) and then declined with a similar time course. Urinary levels of formic acid, which is eliminated by oxidation by a folate-dependent pathway, were significantly increased by ethanol administration, thus indicating another ethanol-folate interaction. Concurrent administration of 4-MP suppressed the increased excretion of formate but had no effect on the increased excretion of folate in ethanol-treated rats. These studies suggest that ethanol has two distinct effects on folate metabolism, one dependent and one independent of ethanol metabolism.