Comparing the Clinical Characteristics, Laboratory Findings, and Outcomes between Epidemic and Episodic Methanol Poisoning Referrals; a Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e46
https://doi.org/10.22037/aaem.v9i1.1278
Abstract
Introduction: Due to illegal manufacturing and sales of alcoholic beverages, epidemic outbreaks of methanol poisoning may occur. The aim of this study was to determine if there were differences in the severity, course of poisoning, and outcomes between methanol-poisoned patients admitted during an outbreak versus those who were admitted following episodic exposures.
Methods: The present retrospective study was performed in a single referral poisoning center between March 2018 and March 2019 in patients with confirmed methanol poisoning. During this time, in addition to episodic cases of methanol intoxication, there were three methanol poisoning outbreaks. Outbreaks were characterized by an unexpected increase in the number of methanol-poisoned patients in a short period of time, which impacted resources and decision-making. The two groups were compared regarding their severity of poisoning, sessions of hemodialysis, and clinical outcomes.
Results: Outbreak cases had a higher level of methanol than episodic cases. Odds of being dialyzed more than once was 5.4 times higher in the cases presenting during an outbreak (95% CI 2.1-14.0; p=0.001). Mean hospital stay, intubation/mechanical ventilation, and death were similar between the two groups. An evaluation of the alcoholic beverage samples available in the Iranian black market during the outbreak showed a 7-percent methanol concentration with no ethanol content.
Conclusions: Poisoning risk may be higher during methanol outbreaks due to the higher methanol concentrations, requiring more hemodialysis sessions for persistent metabolic acidosis. In addition to alcohol dehydrogenase blockade, careful risk assessment of all methanol poisonings can assist with stratifying the priority for, and duration of, hemodialysis to optimize outcomes.
- Methanol
- poisoning
- disease outbreaks
- renal dialysis
- formaldehyde poisoning
How to Cite
References
Hassanian-Moghaddam H, Zamani N. A brief review on toxic alcohols: management strategies. Iranian journal of kidney diseases. 2016;10(6):344.
Hassanian-Moghaddam H, Zamani N, Roberts DM, Brent J, McMartin K, Aaron C, et al. Consensus statements on the approach to patients in a methanol poisoning outbreak. Clinical toxicology. 2019;57(12):1129-36.
Hassanian-Moghaddam H, Pajoumand A, Dadgar S, Shadnia S. Prognostic factors in methanol poisoning. Human & experimental toxicology. 2007;26(7):583-6.
Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes–a multicenter study. Clinical Toxicology. 2012;50(9):823-31.
Sefidbakht S, Rasekhi A, Kamali K, Haghighi AB, Salooti A, Meshksar A, et al. Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology. 2007;49(5):427-35.
Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran—a cross-sectional assessment. Critical Care. 2020;24(1):1-3.
Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, Saberinia A, Nasehi AA, Masoumi Asl H, et al. Methanol mass poisoning in Iran: role of case finding in outbreak management. Journal of public health. 2015;37(2):354-9.
Pajoumand A, Zamani N, Hassanian-Moghaddam H, Shadnia S. Can duration of hemodialysis be estimated based on the on-arrival laboratory tests and clinical manifestations in methanol-poisoned patients? International urology and nephrology. 2017;49(6):1057-62.
Zakharov S, Pelclova D, Navratil T, Belacek J, Komarc M, Eddleston M, et al. Fomepizole versus ethanol in the treatment of acute methanol poisoning: comparison of clinical effectiveness in a mass poisoning outbreak. Clinical Toxicology. 2015;53(8):797-806.
Kute VB, Godara SM, Shah PR, Gumber MR, Goplani KR, Vanikar AV, et al. Hemodialysis for methyl alcohol poisoning: A single-center experience. Saudi Journal of Kidney Diseases and Transplantation. 2012;23(1):37.
Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Critical care medicine. 2015;43(2):461-72.
Baud FJ, Borron SW, Bavoux E, Astier A, Hoffman JR. Relation between plasma lactate and blood cyanide concentrations in acute cyanide poisoning. Bmj. 1996;312(7022):26-7.
Dudka J, Burdan F, Szumilo J, Tokarska E, Korobowicz A, Klepacz R, et al. Effect of selected alcohol dehydrogenase inhibitors on human hepatic lactate dehydrogenase activity—an in vitro study. Journal of Applied Toxicology: An International Journal. 2005;25(6):549-53.
Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings. Medical toxicology. 1986;1(5):309-34.
Shahangian S, Ash K. Formic and lactic acidosis in a fatal case of methanol intoxication. Clinical chemistry. 1986;32(2):395-7.
Sanaei-Zadeh H, Esfeh SK, Zamani N, Jamshidi F, Shadnia S. Hyperglycemia is a strong prognostic factor of lethality in methanol poisoning. Journal of Medical Toxicology. 2011;7(3):189-94.
Lee C-Y, Chang EK, Lin J-L, Weng C-H, Lee S-Y, Juan K-C, et al. Risk factors for mortality in Asian Taiwanese patients with methanol poisoning. Therapeutics and clinical risk management. 2014;10:61.
Cavalli A, Volpi A, Maggioni AP, Tusa M, De Pieri G. Severe reversible cardiac failure associated with methanol intoxication. Postgraduate medical journal. 1987;63(744):867-8.
- Abstract Viewed: 1178 times
- pdf Downloaded: 329 times
