Severe methanol poisoning

McCoy, Harry G.; Cipolle, Robert J.; Ehlers, Sally M.; Sawchuk, Ronald J.; Zaske, Darwin E.

doi:10.1016/0002-9343(79)90738-1

Cited by 115 publications

(7 citation statements)

References 15 publications

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“… 1 , 2 , 3 , 4 , 5 Hemodialysis (HD) can efficiently remove methanol and its toxic metabolite formic acid while correcting metabolic acidosis and improving patient outcome. 4 , 5 , 6 , 7 Current guidelines suggest instituting HD when the methanol concentration is >15.6 mmol/l (50 mg/dl) until concentrations are inferior to 6.25 mmol/l (20 mg/dl) and acid–base disturbance has been corrected. 8 , 9 However, methanol concentrations may not be readily available in an appropriate time frame, which may lead to either undue prolongation or premature termination of HD.…”

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confidence: 99%

Prediction and validation of hemodialysis duration in acute methanol poisoning

Lachance

Desmeules

Serres

et al. 2015

Kidney International

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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.

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confidence: 99%

Prediction and validation of hemodialysis duration in acute methanol poisoning

Lachance

Desmeules

Serres

et al. 2015

Kidney International

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“…Rapidly absorbed from the gastrointestinal tract, MeOH is metabolized first to formaldehyde by alcohol dehydrogenase, and finally to formic acid by aldehyde dehydrogenase in the liver 3, 4, 5. If ingested in massive quantities, fomepizole, an alcohol dehydrogenase inhibitor, should be given as soon as possible before liver metabolism progresses, and HD should be carried out to remove MeOH 6, 7, 8, 9. Plasma osmolality is determined mainly by Na + , its counter ions, and uncharged species such as glucose and blood urea nitrogen.…”

Section: Discussionmentioning

confidence: 99%

Mild manifestation of methanol poisoning half a day after massive ingestion of a fuel alcohol product containing 70% ethanol and 30% methanol: a case report

Yoshizawa

Kamijo

Fujita

et al. 2018

Acute Medicine & Surgery

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CaseIs fomepizole necessary after massive ingestion of a mixture of methanol and ethanol? We report the case of a 37‐year‐old man who was transported to our Poison Center 12 h after ingesting 500 mL of fuel alcohol containing 70% methanol and 30% ethanol in a suicide attempt. On admission, he presented only with somnolence and mild metabolic acidosis. We hypothesized that most of the ethanol had been metabolized.OutcomeAs the estimated serum concentration of methanol was lethal (242.6 mg/dL), fomepizole was given i.v. and hemodialysis was carried out twice, resulting in complete recovery. Later, the serum concentrations of both methanol and ethanol on admission were found to be 224.1 and 0.51 mg/dL, respectively.ConclusionTherapeutic intervention was delayed by half a day after ingestion of a product containing methanol and ethanol in the present case. If the patient had arrived earlier, he may have only been treated with hemodialysis, but not fomepizole.

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“…Baseline measurements were obtained and an infusion of ethanol (10% ethanol in D,W, eight patients) or placebo (D,W, seven patients) was begun through a peripheral vein. Ethanol (6 ml/kg) in 500 ml D, W was infused over 30 min to produce a blood-alcohol level of approximately 100 mg/dl (9). Measurements were made at the midpoint and end of the infusion.…”

Section: Methodsmentioning

confidence: 99%

The effects of ethanol administration on portal pressure and gastroesophageal collateral blood flow in patients with alcoholic cirrhosis

Ready¹,

Hossack

1990

Hepatology

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The pathogenesis of variceal hemorrhage is not well understood. Portal pressure and gastroesophageal collateral (azygous) blood flow are similar in patients with cirrhosis with or without a history of variceal bleeding. However, acute increases in these parameters in individual patients might predispose them to variceal rupture. Fifteen patients with alcoholic cirrhosis and portal hypertension were evaluated to test the hypothesis that ethanol intake acutely increases portal pressure or gastroesophageal blood flow and is a possible risk factor in variceal hemorrhage. A 10% solution of ethanol in 5% dextrose in water was infused intravenously at a rate sufficient to raise the blood-alcohol level to 100 mg/dl over 30 min. Eight patients received ethanol 5% dextrose in water; seven patients received a placebo (5% dextrose in water alone). Ethanol did not produce a significant change in wedged hepatic-vein pressure, free hepatic-vein pressure, azygous blood flow, mean arterial pressure or heart rate compared with the effects of 5% dextrose in water alone. Acute administration of ethanol does not increase portal pressure or gastroesophageal blood flow. It is unlikely that acute ethanol ingestion is a risk factor for variceal hemorrhage.

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Severe methanol poisoning

Cited by 115 publications

References 15 publications

Prediction and validation of hemodialysis duration in acute methanol poisoning

Prediction and validation of hemodialysis duration in acute methanol poisoning

Mild manifestation of methanol poisoning half a day after massive ingestion of a fuel alcohol product containing 70% ethanol and 30% methanol: a case report

The effects of ethanol administration on portal pressure and gastroesophageal collateral blood flow in patients with alcoholic cirrhosis

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