Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes – a multicenter study

Abstract

INTRODUCTION. Thorough prognostic and metabolic studies of methanol poisonings are scarce. Our aims were to evaluate the factors associated with sequelae and death from methanol poisoning, to develop a simple risk-assessment chart to evaluate factors associated with sequelae and death from methanol poisoning, and to compare the antidotes ethanol and fomepizole. PATIENTS AND METHODS. We present a retrospective observational case series of methanol-poisoned patients from Norway (1979 and 2002-2005), Estonia (2001) and Tunisia (2003/2004), and patients from two different centers in Iran (Teheran 2004-2009 and Mashhad 2009-2010) who were identified by a positive serum methanol and had a blood acid-base status drawn on admission. The patients were divided into different groups according to their outcome: Survived, survived with sequelae, and died. RESULTS. A total of 320 patients were identified and 117 were excluded. Of the remaining 203 patients, 48 died, and 34 were discharged with neurological sequelae. A pH < 7.00 was found to be the strongest risk factor for poor outcome, along with coma (Glasgow Coma Scale (GCS) < 8) and a pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00. More patients died despite hyperventilation (low pCO(2)) in the ethanol group. CONCLUSIONS. Low pH (pH < 7.00), coma (GCS < 8), and inadequate hyperventilation (pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00) on admission were the strongest predictors of poor outcome after methanol poisoning. A simple flow-chart may help identify the patients associated with a poor outcome.

Fomepizole in the treatment of acute methanol poisonings: Experience from the Czech mass methanol outbreak 2012-2013

“…In an earlier study of Paasma et al, there was a trend to a "positive" shift in morbidity and mortality (i.e., a better outcome) in the fomepizole group relative to the ethanol group regarding the pH, but this difference was not significant 38 . In our study, the patients treated with fomepizole who survived with visual/ CNS injury had a median pH 6.92 (6.65-7.25, n=10), that was lower than the median pH 7.02 (6.65-7.39, n=20) of all the patients surviving methanol poisoning with visual/ CNS impairment during the Czech mass methanol outbreak 2012 (ref.…”

Metanol Zehirlenmesi: Olgu Sunumu

“…Prognozda hastanın ilk başvurduğu dönemdeki Ph düzeyi önemlidir (7,8). Ciddi asidoz ve koma kötü prognoza işaret ederken hastanın geldiği anda bilincinin açık olması ve hiperventilasyon yapabilmesi iyi prognoza işarettir (8,9).…”

Toxicology and the biological role of methanol and ethanol: Current view

“…Intermittent hemodialysis, continuous veno-venous hemodialysis and hemodiafiltration can be exampled as other effective techniques 102 . Hyperventilation is presented as another available supporting therapy during severe poisoning 103 . Drinking of ethanol or ethanol containing beverage is the simplest antidotal therapy during poisoning with the most toxic alcohols such as methanol or ethylene glycol.…”