Methanol poisoning and heparin: A dangerous couple?

Hernández, Miguel Ángel; Peña, M.S. Holanda; Tejerina, Eva; González, Cristina Renedo; López, Marta Reyero; Hernández, J.L.

doi:10.1016/j.ajem.2004.08.004

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…[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%

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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Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…10 The mechanism of hemorrhage has been associated with systemic anticoagulation during hemodialysis. [11][12][13] Nevertheless, Zakharov et al did not reveal a relationship between systemic anticoagulation and brain hemorrhages. Rather, they attributed the hemorrhagic risk to predisposing factors.…”

Section: Discussionmentioning

confidence: 99%

Late hemorrhagic transformation of brain lesions in case with methanol intoxication

2022

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Methanol intoxication can be occurred as accidental or suicidal ingestion or intentional ingestion through abuse. Formic acid is the primary toxic metabolite which causes high anion gap metabolic acidosis and end-organ damage in the human body. Here we presented a 46-year-old man who loss of consciousness on the 23rd day of hospitalization and his cranial computed tomography revealed bilateral subcortical hemorrhages. This case indicates us an example of late appearance of hemorrhagic transformation in methanol intoxication.

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“…With very high methanol levels, dialysis may need to be undertaken for 18–21 hours and the procedure repeated after 24 hours if there is rebound toxicity. Most experts recommend against using heparin anticoagulation during dialysis because of the risk of intracranial hemorrhage, particularly in the basal ganglia 31,32 . Hemodialysis provides a clearance of 200 mL/min for methanol and 223 mL/min for formate at blood flows of 100–400 mL/min.…”

Section: Discussionmentioning

confidence: 99%

“…Most experts recommend against using heparin anticoagulation during dialysis because of the risk of intracranial hemorrhage, particularly in the basal ganglia. 31,32 Hemodialysis provides a clearance of 200 mL/min for methanol and 223 mL/min for formate at blood flows of 100-400 mL/ min. But the endogenous elimination half-life of formate was not found to be statistically different from the elimination half-life on dialysis (205 AE 90 vs. 150 AE 37 min) in one study.…”

Section: Renal Replacement Therapy Is Recommended Whenmentioning

confidence: 99%

Dialysis in the poisoned patient

Bayliss

2010

Hemodialysis International

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Patients who ingest toxic substances may require extracorporeal removal of the poisons or their toxic metabolites if native renal clearance is not sufficient because of acute kidney injury, acuity of symptoms, or burden of toxin. Here, a case is presented, and the literature on renal replacement therapy in the event of acute intoxication is reviewed. Extracorporeal therapy efficacy is examined in terms of the characteristics of the toxin (molecular size, charge, protein, or lipid binding); the patient (body habitus and volume of distribution); and the process (membrane effects on extraction ratios and sieving, role of blood, and dialysate flow rates). The choice of extracorporeal therapy and hemodialysis prescriptions for specific poisonings are discussed.

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Methanol poisoning and heparin: A dangerous couple?

Cited by 8 publications

References 6 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

Late hemorrhagic transformation of brain lesions in case with methanol intoxication

Dialysis in the poisoned patient

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