Bilateral putaminal hemorrhage related to methanol poisoning: a complication of hemodialysis? Case report

Filho, Miguel Giudicissi; Holanda, Carlos Vanderlei M. de; Nader, Nelson A.; Gomes, Sergio R. P.; Bertolucci, Paulo Henrique Ferreira

doi:10.1590/s0004-282x1995000300020

Cited by 15 publications

(15 citation statements)

References 7 publications

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“…[9] reported 6 of 21 patients and Giudicissi et al . [5] reported one case with brain hemorrhagic necrosis after HD, suggesting a deleterious role of systemic anticoagulation during HD.…”

Section: Discussionmentioning

confidence: 99%

“…[56] There is a debate on the association of brain hemorrhage in methanol toxicity and application of systemic anticoagulation during hemodialysis (HD). [56] Previous studies report a brain hemorrhage rate of 13.5%–16.4% in methanol-poisoned patients on presentation, but there are limited studies on patients who developed hemorrhages after presentation with on-arrival normal imaging studies. [7] We present an interesting case to review brain CT scanning of a methanol-intoxicated patient in different time intervals before and after conventional HD.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial hemorrhage in methanol toxicity: Challenging the probable heparin effect during hemodialysis

et al. 2017

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Brain hemorrhages are rare complications of acute methanol poisoning. There is a debate on association of brain hemorrhage in methanol toxicity and application of systemic anticoagulation during hemodialysis (HD). A 70-year-old male presented to us with severe metabolic acidosis and a methanol level of 7.6 mg/dL. Ethanol and folinic acid were administered, and HD was performed. Brain computed tomography (CT) scan which was normal on presentation showed extensive bilateral subcortical supratentorial hypodensities on the 3rd day after commencing the treatment. However, the next CT scan performed 2 weeks later revealed expanding hemorrhagic transformation in previous hypodensities. Hemorrhagic changes could not be explained by patient's coagulation profile on the 3rd day. Anticoagulation agents such as heparin are used routinely during a dialysis session to prevent clot formation in dialysis circuits. This case is possibly questioning the role of heparin in hemorrhagic brain lesions of methanol intoxication.

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“…[9] reported 6 of 21 patients and Giudicissi et al . [5] reported one case with brain hemorrhagic necrosis after HD, suggesting a deleterious role of systemic anticoagulation during HD.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracranial hemorrhage in methanol toxicity: Challenging the probable heparin effect during hemodialysis

et al. 2017

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“…Brain haemorrhages are considered rare complications of acute methanol poisoning that have been connected by some authors to the application of systemic anticoagulation during haemodialysis . Phang et al .…”

Section: Importancementioning

confidence: 99%

“… reported the appearance of brain haemorrhage in 13.5% of patients with acute methanol poisoning. Several authors recommend against using heparin anticoagulation during dialysis because of the risk of intracranial bleeding .…”

Section: Importancementioning

confidence: 99%

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

Zakharov

Kotikova

Vaněčková

et al. 2016

Basic Clin Pharma Tox

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Abstract:The purpose was to study the prevalence and predisposing factors of brain lesions in survivors of acute methanol poisoning. Clinical data on 106 patients with methanol poisoning were collected during the Czech mass poisoning outbreak. Of 83 survivors, in 46 (55%) patients, follow-up examinations including magnetic resonance imaging of brain (MR) were performed 3-8 and 24-28 months after discharge from the hospital. Of 46 patients with a median age of 49 (interquartile range, 35-57) years, 24 (52%) patients had a total of 40 abnormal brain findings with haemorrhagic lesions detected in 15 (33%) and non-haemorrhagic lesions found in 9 (19%) patients. The patients with haemorrhagic brain lesions were more acidemic (lower arterial blood pH, higher base deficit) and had higher glycaemia and lactacidaemia on admission than those without haemorrhages (all p < 0.05). Thirteen of 32 (41%) of patients with systemic anticoagulation and 2 of 14 (14%) of patients without it had haemorrhagic lesions (p = 0.080). Bleeding complications during the treatment occurred in 4 of 15 (27%) patients, and 5 of 15 (33%) patients had conditions predisposing to haemorrhage in the group with haemorrhagic lesions. In three cases with a series of computer tomography (CT)/MR performed during hospitalization, the necrotic lesions in the brain remained non-haemorrhagic during hospitalization and haemorrhagic lesions were detected on the follow-up MR examinations only. No association between brain haemorrhages and systemic anticoagulation during dialysis was found: brain haemorrhages might occur in severely poisoned patients treated without systemic anticoagulation, whereas treatment with high doses of heparin might not lead to brain haemorrhages.Methanol poisoning due to the consumption of illicit alcoholic beverages represents an important medical problem throughout the world [1][2][3][4][5]. This poisoning generally occurs either intentionally through abuse or attempted suicide or unintentionally through misuse or accident [6,7]. Despite the progress in diagnosis and treatment of methanol poisoning, morbidity and mortality are still high [8,9]. If therapeutic measures are inadequate or delayed, mortality may exceed 40% and serious longterm visual and central nervous system (CNS) sequelae may occur [10][11][12]. The strategy of active case finding and prehospital ethanol administration in the patients with suspected poisoning can improve outcome in a large-scale outbreak of methanol poisoning [13,14].Methanol in the human organism is metabolized to the highly toxic formic acid/formate ion, which inhibits mitochondrial respiration [15][16][17][18]. The accumulation of formic acid results in metabolic acidosis, visual impairment and damage to basal ganglia [19][20][21]. Rapid administration of antidotes and haemodialysis are crucial for successful treatment [22][23][24][25]. Importance.The role of haemodialysis in the treatment of methanol poisoning is well-established: it effectively eliminates both methanol and formate and helps to cor...

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“…In 2006, Sebe et al reported a temporal lobe and bilateral occipital haemorrhage in the cranial CT scan of a patient with methanol toxicity that occurred following haemodialysis 8. Likewise, Giudicissi et al and Phang et al indicated that systemic anticoagulation during haemodialysis induces haemorrhage 9 , 10. In contrast, another study on the treatment of methanol toxicity showed no haemorrhagic changes in patients who underwent haemodialysis 8…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal and urinary tract bleeding in methanol toxicity

Mostafazadeh

Talaie²,

Mahdavinejad³

et al. 2008

Case Reports

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Methanol is a clear, colourless liquid with a smell and taste similar to ethanol. Intoxications with methanol are still frequent in large parts of the developing world. Haemodialysis should be done in cases of severe toxicity to eliminate toxic metabolites. In this case report, we describe a 37-year-old chronic alcohol abuser with methanol poisoning, who developed haematuria and upper gastrointestinal (GI) bleeding after haemodialysis. The upper GI endoscopic findings showed only low grade oesophageal ulceration. Haematuria and upper GI bleeding in our patient might also have cause by the effect of heparinisation during haemodialysis.

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Bilateral putaminal hemorrhage related to methanol poisoning: a complication of hemodialysis? Case report

Cited by 15 publications

References 7 publications

Intracranial hemorrhage in methanol toxicity: Challenging the probable heparin effect during hemodialysis

Intracranial hemorrhage in methanol toxicity: Challenging the probable heparin effect during hemodialysis

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

Gastrointestinal and urinary tract bleeding in methanol toxicity

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