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Background: We investigated one of the largest outbreaks of methanol toxicity on record. Our aims were to describe the outbreak, assess the adequacy of therapy rendered, and identify factors indicating a poor prognosis. Methods: We developed statistics from questionnaires, medical records, and autopsy and laboratory reports. Results: During the month of October 2000, a total of 211 cases occurred, predominantly in the East-Central part of El Salvador, when methanol was introduced into the alcohol supply. The outbreak principally involved males (98%), largely of middle age (median age 42; 10th & 90th percentiles 24, 64), who were primarily agricultural day laborers (84%). The death-to-case ratio was high (61%). Patients had been regularly intoxicated with ethanol for from 1 to 90 days (median 4 days) prior to illness. The following numbers and percentages of the 159 patients reaching a healthcare facility alive received: hemodialysis (2, 1.2%), ethanol (58, 37%), fomepizole (0, 0%), sodium bicarbonate (11, 7%), folinic or folic acid (33, 21%), and intravenous fluids (126, 79%). Only 4 (2.5%) had a blood pH or serum bicarbonate measurement, and only 1 (0.6%) had blood ethanol and/or methanol measurements made during life. Having visual symptoms or altered mental status at the time of presentation to the health care facility was associated with a fatal outcome (P = 0.005 and 0.004, respectively). Conclusions: A large proportion (over 40%) of the 128 deaths occurred before the victim could receive health care. Standard diagnostic and therapeutic maneuvers were infrequently used. Acute visual symptoms and altered mental status heralded a fatal outcome. Improved secondary prevention will require improved access to necessary diagnostic tests, drugs, and equipment and enhanced knowledge among Salvadoran physicians of how to treat methanol poisoning., Armero JA(1), Suarez GI(1), Kilbourne EM(2), Hernandez R(1), Mixco M(1). (1)Ministry of Public Health and Social Assistance and Institute of Legal Medicine, El Salvador; (2)Agency for Toxic Substances & Disease [...]