A review of our current understanding of the epidemiology, clinical manifestations, diagnosis, dose/response, and treatment data for acute methanol poisoning is presented with a focus on methanol ingestions.13,028 acute gasoline exposure cases reported to the American Association of Poison Control Centers in 1987 are analyzed, followed by a more detailed analysis of 230 of these reports to gain insight into the circumstances surrounding acute gasoline exposures. These data allow rough projections of the incidence of methanol poisoning, morbidity, and mortality, following the proposed widespread use of methanol fuels. The analysis of 230 ingestion scenarios revealed several patterns. Teenage and young adult males (15to 29 years old) were involved in 388% of ingestion cases, nearly always as a result of siphoning. Accidental ingestions in children under six years accounted for 36.2% of reported ingestions. In most of the pediatric cases, fuel cans or container transfers were implicated. Extrapolation of 1987 data reported by 63 U.S. poison centers to the American Association of Poison Control Centers provides current annual incidence estimates of 6400 methanol exposures, 52,000 gasoline exposures, and 35,000 gasoline ingestions. Widespread application of methanol fuels would shift the clinical focus for these 35,000 annual ingestion cases. Methanol, in contrast to gasoline, poses a high risk of systemic toxicity, with a misleading delay in the appearance of toxic manifestations, and severe clinical outcomes such as death, permanent blindness, and neurologic impairment following failure to obtain appropriate treatment promptly. Furthermore, the ingested dose which requires invasive treatment (hemodialysis) is lust 0.4 mI/kg, a mere teaspoonful (5 ml) of an 85% methanol fuel in a 10kg one-year-old child, and just 7 ml in a 15 kg three-year-old. Whereas a 70 kg adult would need to ingest 28 ml (less than one ounce) to obtain a level which requires hemodialysis, this amount could easily be swallowed in a siphoning accident by a young adult male. Similar extrapolations from the oft-cited potentially lethal methanol dose of 1 ml/kg is equivalent to just 12 ml (less than a tablespoonful) of an 85% methanol fuel in a 10 kg 1 -year-old, and just 18 ml in a 15 kg 3-year-old. Based on the reported 0.375% methanol mortality rate, the widespread use of methanol fuels could increase the number of methanol fatalities by 195/year, up from the current (extrapolated) 24/year).Similarly, a dramatic increase in the occurrence of blindness and permanent neurologic impairment as predicted, though the absolute number of cases cannot be estimated as current statistics are unavailable. Excluding the costs of extended hospitalizations for complications of methanol poisoning, chronic care and rehabilitation for severe permanent blindness or neurologic impairment, and loss of life, the increased acute health care expenditure alone exceeds 50 to 100 million dollars annually. From a public health vantage, the acute hazard posed by conversion to methanol fuels is unacceptable due to the predicted increases in fatalities, blindness, and permanent neurologic disability secondary to more frequent ingestions. Prior to conversion to a predominantly methanol fleet, innovative closures and packaging techniques must be developed which prevent siphoning and limit access by small children. Extensive public and health professional education will be required, focusing on the lethal consequences and permanent sequelae which follow methanol poisoning, the need to prevent accidental ingestion, and the urgency with which treatment must be undertaken despite the absence of clinical manifestations of toxicity. Container transfer should be discouraged and clear, emphatic warning labels prominently displayed on all fuel containers and around the fuel tank orifice of each vehicle. These warnings should clearly and emphatically state that death or blindness is likely if even small