Methanol mass poisoning in Estonia: Outbreak in 154 patients

Paasma, Raido; Hovda, Knut Erik; Tikkerberi, A.; Jacobsen, Dag

doi:10.1080/15563650600956329

Cited by 180 publications

(161 citation statements)

References 16 publications

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“…Visual disturbances, including decreased visual acuity, photophobia, and blurred vision, and abdominal pain are the most common symptoms of methanol intoxication (7,64), one or both being found in 37 to 72% of patients (7,64). Hyperemia of the optic disks and a reduced papillary response to light may be present.…”

Section: Clinical Findingsmentioning

confidence: 99%

“…The severity of the visual abnormalities is directly correlated with the severity of the metabolic acidosis (6,7,12). Although most patients will recover normal visual function, permanent impairment of vision has been observed in from 11 to 18% of patients (7,64). Abdominal pain can be present in both the presence and the absence of pancreatitis (7,12).…”

Section: Clinical Findingsmentioning

confidence: 99%

“…It usually results from accidental ingestion of products containing methanol or ingestion as a method of attempting suicide or is taken in lieu of ethanol when the latter is in short supply (7,64,65).…”

Section: Epidemiologymentioning

confidence: 99%

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Toxic Alcohol Ingestions

Kraut¹,

Kurtz²

2008

Clinical Journal of the American Society of Nephrology

355

326

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Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early. Table 1. Methanol, ethylene glycol, diethylene glycol, and propylene glycol intoxication and alcoholic ketoacidosis can produce hyperosmolality and metabolic acidosis (3-9). Isopropanol intoxication is usually associated with hyperosmolality alone (4,5). Importantly, several of these disorders can be fatal or produce irreversible tissue damage if they are not quickly recognized and treated appropriately (4 -15). Effect of Alcohols on Serum Osmolality and the Osmolal GapThe normal serum osmolality of 285 to 290 mOsm/L is due to sodium and its counterbalancing ions, bicarbonate and chloride, and glucose and urea. It can be calculated using the following equation:Serum osmolality (mOsm/L) ϭ 2 ϫ Na ϩ ϩ blood urea nitrogen (mg/dl)/2.8 ϩ glucose (mg/dl)/18. The serum osmolality measured by freezing point depression is usually within 10 mOsm/L of the calculated serum osmolality (16). Accumulation of low molecular weight substances in the serum (such as each of the alcohols) will raise the measured serum osmolality above that of the calculated serum osmolality, producing an osmolal gap (4,5,16 -18). The effect of each of the alcohols on serum osmolality is shown in Table 2. Methanol gives rise to the greatest increment in serum osmolality, followed by ethanol, isopropanol, ethylene glycol, propylene glycol, and diethylene glycol in that...

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Section: Clinical Findingsmentioning

confidence: 99%

Section: Clinical Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Toxic Alcohol Ingestions

Kraut¹,

Kurtz²

2008

Clinical Journal of the American Society of Nephrology

355

326

View full text Add to dashboard Cite

show abstract

“…To test this hypothesis, the affinity of abacavir for ADH in comparison with methanol should firstly be experimentally determined and if it is shown that it has a greater affinity for ADH compared with methanol, a multicenter randomized controlled trial study should be designed to compare fomepizole with abacavir in the treatment of methanol-poisoned patients. Albeit, the best opportunities for conducting this study are the mass poisonings with methanol that regularly occur in developed and developing countries [9,[18][19][20][21].…”

mentioning

confidence: 99%

“…In contrary, methanol poisoning is a rare toxicity that is seen in the form of isolated episodes and intentional ingestion, and sometimes occurs as single epidemies [9,[18][19][20][21]. Therefore, fomepizole is not widely stocked in some hospital pharmacy stocks in comparison…”

mentioning

confidence: 99%