Current tests for methanol poisoning
Methanol can be tested by using chromatographic methods. These are reliable, but they require heavy laboratory-based equipment and skilled technicians. Also, the methanol level can be negative in the late stages when all methanol is metabolized.
Indirect methods using the osmolal- and anion gaps can be used, but they are unspecific and have inherent limitations. More importantly, osmolality measured by a proper technique (freezing point-depression method) is hardly ever available in the low- and middle income countries: The vapor-pressure method typically used in blood gas analyzers does not detect alcohols, and must therefore never be used.
The majority of methanol poisoning outbreaks happen in countries where resources are limited, and specific knowledge is highly varying. Thus, simplification of the diagnostic process is warranted.
A diagnostic test should not rely on laboratory equipment or -infrastructure; it should be stable during transport and storage, and it should be able to detect and semi-quantitatively determine formate concentration in full blood (i.e. no need for sentrifuging/spinning) in emergency situations.