{
  "id": "medical/ethylene-glycol-methanol-dosing",
  "signature": "AI calculates fomepizole loading dose for methanol poisoning using patient's actual body weight exceeding 100 kg without capping at 100 kg, causing tenfold overdose",
  "signature_zh": "AI计算甲醇中毒的甲吡唑负荷剂量时使用超过100kg的患者实际体重而未设上限，导致十倍过量",
  "regex": "(?i)(fomepizole|antizol).*loading.*dose.*(weight|kg).*150|overdose.*fomepizole",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Fomepizole (Antizol) loading dose is 15 mg/kg IV, but the recommended maximum single dose is 1.5 g (for patients >100 kg, use ideal body weight or cap at 100 kg) to avoid toxicity from the propylene glycol vehicle; AI ignored this cap for a 150 kg patient, calculating 2.25 g.",
  "root_cause_type": "generic",
  "root_cause_zh": "甲吡唑（Antizol）负荷剂量为15 mg/kg静脉注射，但推荐单次最大剂量为1.5 g（体重>100kg的患者使用理想体重或上限100kg），以避免丙二醇溶剂的毒性；AI对150kg患者未设上限，计算为2.25g。",
  "versions": [
    {
      "version": "Antizol Prescribing Information 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Goldfrank's Toxicologic Emergencies 11th Ed",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "EXTRIP Workgroup Guidelines for Methanol Poisoning 2022",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Using lean body weight formula (Boer) for all patients — underestimates dose for obese patients and may lead to subtherapeutic levels",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Assuming the dose can be rounded up to nearest vial (1.5 g vial) — 2.25 g requires opening two vials and discarding part, risking contamination",
      "fail_rate": 0.55,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Using adjusted body weight (IBW + 0.4*(ABW-IBW)) — not validated for fomepizole and may still exceed safe limits",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Cap the weight at 100 kg for dose calculation: `dose_mg = min(patient_weight_kg, 100) * 15`. For a 150 kg patient: 100 * 15 = 1500 mg = 1.5 g (one vial). Verify with pharmacy: `python -c \"print(min(150,100)*15)\"`",
      "success_rate": 0.95,
      "how": "Cap the weight at 100 kg for dose calculation: `dose_mg = min(patient_weight_kg, 100) * 15`. For a 150 kg patient: 100 * 15 = 1500 mg = 1.5 g (one vial). Verify with pharmacy: `python -c \"print(min(150,100)*15)\"`",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use ideal body weight (IBW) for obese patients: IBW (males) = 50 + 0.91*(height_cm - 152.4), IBW (females) = 45.5 + 0.91*(height_cm - 152.4). Then calculate dose = IBW * 15 mg/kg. Document in MAR: `Fomepizole 1.5 g IV (capped at 100 kg IBW)`",
      "success_rate": 0.9,
      "how": "Use ideal body weight (IBW) for obese patients: IBW (males) = 50 + 0.91*(height_cm - 152.4), IBW (females) = 45.5 + 0.91*(height_cm - 152.4). Then calculate dose = IBW * 15 mg/kg. Document in MAR: `Fomepizole 1.5 g IV (capped at 100 kg IBW)`",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Cap the weight at 100 kg for dose calculation: `dose_mg = min(patient_weight_kg, 100) * 15`. For a 150 kg patient: 100 * 15 = 1500 mg = 1.5 g (one vial). Verify with pharmacy: `python -c \"print(min(150,100)*15)\"`",
    "Use ideal body weight (IBW) for obese patients: IBW (males) = 50 + 0.91*(height_cm - 152.4), IBW (females) = 45.5 + 0.91*(height_cm - 152.4). Then calculate dose = IBW * 15 mg/kg. Document in MAR: `Fomepizole 1.5 g IV (capped at 100 kg IBW)`"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8f7a6b1a-0c5d-4b3e-9f2a-1e8c7d6b5a4c",
  "official_doc_section": null,
  "error_code": "TOX-DOSE-CAP-ERR-002",
  "verification_tier": "ai_generated",
  "confidence": 0.85,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-05-20",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}