Prediction and validation of hemodialysis duration in acute methanol poisoning

Abstract

The duration of hemodialysis (HD) in methanol poisoning (MP) is dependent on the methanol concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. However, methanol assays are not easily available, potentially leading to undue extension or premature termination of treatment. Here we provide a prediction model for the duration of high-efficiency HD in MP. In a retrospective cohort study, we identified 71 episodes of MP in 55 individuals who were treated with alcohol dehydrogenase inhibition and HD. Four patients had residual visual abnormality at discharge and only one patient died. In 46 unique episodes of MP with high-efficiency HD the mean methanol elimination half-life (T1/2) during HD was 108 min in women, significantly different from the 129 min in men. In a training set of 28 patients with MP, using the 90th percentile of gender-specific elimination T1/2 (147 min in men and 141 min in women) and a target methanol concentration of 4 mmol/l allowed all cases to reach a safe methanol of under 6 mmol/l. The prediction model was confirmed in a validation set of 18 patients with MP. High-efficiency HD time in hours can be estimated using 3.390 × (Ln (MCi/4)) for women and 3.534 × (Ln (MCi/4)) for men, where MCi is the initial methanol concentration in mmol/l, provided that metabolic acidosis is corrected.

Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning

“…Using a similar approach, we have previously proposed a prediction model of HD duration in methanol poisoning based on the initial methanol concentration in a group of 28 cases. 8 This model was subsequently confirmed in a validation set of 18 cases. Although methanol and EG have very similar chemical and toxicokinetic characteristics (volume of distribution, protein binding, absorption), it is unclear why there was a longer T 1/2 for EG in this study.…”

“…This study is a continuation of a previous study in which the same hypothesis was tested in a cohort of patients with methanol poisoning. 8 The aims of this study are to describe the presentation, outcomes, and EG kinetics in a cohort of patients with EG intoxication; to use a training set of cases of EG poisoning to determine T 1/2 during HD and present a simplified model for predicting HD duration; and to validate this model in an independent set of cases.…”

Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents

“…[5–7] There have been recent attempts to generate a nomogram for choosing the appropriate duration of hemodialysis in acute methanol poisoning. [17] …”

Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk‐Prediction Nomogram Approach

“…Currently, there are nomograms available that are used to identify the benefits of antidote therapy in cases of acetaminophen poisoning and toxicity, and arrhythmia risk assessment and to guide the appropriate duration of haemodialysis in cases of acute methanol poisoning using a formula or algorithm involving several predictors modelled as continuous variables to predict an end‐point, according to traditional statistical methods, such as multiple logistic regression and Cox proportional hazards analysis. Nomograms also offer optimal individualized disease‐related risk estimations that simplify patient management‐related decision‐making .…”