Suicide attempt using pure methanol with hospitalization of the patient soon after ingestion: case report

Bucaretchi, Fábio; Capitani, Eduardo Mello De; Madureira, Paulo Roberto de; Cesconetto, Danielle Menezes; Lanaro, Rafael; Vieira, Reinaldo Wilson

doi:10.1590/s1516-31802009000200011

Cited by 15 publications

(11 citation statements)

References 5 publications

(16 reference statements)

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“…Methanol poisoning due to the consumption of illicit alcoholic beverages represents an important medical problem throughout the world . This poisoning generally occurs either intentionally through abuse or attempted suicide or unintentionally through misuse or accident . Despite the progress in diagnosis and treatment of methanol poisoning, morbidity and mortality are still high .…”

Section: Importancementioning

confidence: 99%

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

Zakharov

Kotikova

Vaněčková

et al. 2016

Basic Clin Pharma Tox

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Abstract:The purpose was to study the prevalence and predisposing factors of brain lesions in survivors of acute methanol poisoning. Clinical data on 106 patients with methanol poisoning were collected during the Czech mass poisoning outbreak. Of 83 survivors, in 46 (55%) patients, follow-up examinations including magnetic resonance imaging of brain (MR) were performed 3-8 and 24-28 months after discharge from the hospital. Of 46 patients with a median age of 49 (interquartile range, 35-57) years, 24 (52%) patients had a total of 40 abnormal brain findings with haemorrhagic lesions detected in 15 (33%) and non-haemorrhagic lesions found in 9 (19%) patients. The patients with haemorrhagic brain lesions were more acidemic (lower arterial blood pH, higher base deficit) and had higher glycaemia and lactacidaemia on admission than those without haemorrhages (all p < 0.05). Thirteen of 32 (41%) of patients with systemic anticoagulation and 2 of 14 (14%) of patients without it had haemorrhagic lesions (p = 0.080). Bleeding complications during the treatment occurred in 4 of 15 (27%) patients, and 5 of 15 (33%) patients had conditions predisposing to haemorrhage in the group with haemorrhagic lesions. In three cases with a series of computer tomography (CT)/MR performed during hospitalization, the necrotic lesions in the brain remained non-haemorrhagic during hospitalization and haemorrhagic lesions were detected on the follow-up MR examinations only. No association between brain haemorrhages and systemic anticoagulation during dialysis was found: brain haemorrhages might occur in severely poisoned patients treated without systemic anticoagulation, whereas treatment with high doses of heparin might not lead to brain haemorrhages.Methanol poisoning due to the consumption of illicit alcoholic beverages represents an important medical problem throughout the world [1][2][3][4][5]. This poisoning generally occurs either intentionally through abuse or attempted suicide or unintentionally through misuse or accident [6,7]. Despite the progress in diagnosis and treatment of methanol poisoning, morbidity and mortality are still high [8,9]. If therapeutic measures are inadequate or delayed, mortality may exceed 40% and serious longterm visual and central nervous system (CNS) sequelae may occur [10][11][12]. The strategy of active case finding and prehospital ethanol administration in the patients with suspected poisoning can improve outcome in a large-scale outbreak of methanol poisoning [13,14].Methanol in the human organism is metabolized to the highly toxic formic acid/formate ion, which inhibits mitochondrial respiration [15][16][17][18]. The accumulation of formic acid results in metabolic acidosis, visual impairment and damage to basal ganglia [19][20][21]. Rapid administration of antidotes and haemodialysis are crucial for successful treatment [22][23][24][25]. Importance.The role of haemodialysis in the treatment of methanol poisoning is well-established: it effectively eliminates both methanol and formate and helps to cor...

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Section: Importancementioning

confidence: 99%

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

Zakharov

Kotikova

Vaněčková

et al. 2016

Basic Clin Pharma Tox

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“…Ingestion of small amount of methanol leads to severe acidosis, visual loss, or even death with mortality as high as 29% in an outbreak in Kenya in 2014,7 and thus, IMI is considered to be a method of high lethality. There were only isolated case reports discussing patients who took to MI intentionally,8,9 but with little description on psychiatric comorbidity; most of the current studies take those intoxicated patients as a whole. Thus, in the present study, we aimed to survey psychiatric diagnoses among patients with IMI, and identify distinct characteristics of patients with IMI compared to those with unintentional MI (UMI).…”

Section: Introductionmentioning

confidence: 99%

<p>Psychiatric comorbidities in patients with intentional methanol intoxication</p>

Yang¹,

Yen²,

Juang³

et al. 2019

NDT

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BackgroundIntentional methanol intoxication (IMI) is an emerging public health issue in Asian countries, but few data are available in the literature on underlying psychiatric comorbidities in these suicide attempters.Patients and methodsWe conducted a retrospective chart review on patients with methanol intoxication (MI) treated at Chang-Gung Memorial Hospital, Linkou, Taiwan during 2000–2016. Of the 56 cases of documented MI, 16 were IMI. Baseline demographic, clinical, laboratory, psychiatric diagnoses, and mortality data were collected and analyzed.ResultsPatient group with IMI had more females (62.5% vs 7.5%, P=0.000), less alcohol consumption (33.3% vs 92.5%, P=0.000), and less smoking (40.0% vs 79.5%, P=0.009), but higher past psychiatric disease (73.3% vs 10.0%, P=0.000) and past suicide attempts (81.1% vs 2.5%, P=0.000) than patient group with unintentional MI (UMI). Pesticides (50.0%) comprised the most common source used for suicide, followed by industrial methanol (37.5%). There was no significant difference in mortality rates between these two group (25.0% vs 22.5%, P=0.548). Twelve (75.0%) survivors of IMI were referred to a psychiatric consultation-liaison team, and depressive disorder (58.3%) and adjustment disorder (25.0%) were common.ConclusionThere is a female predominance and a high prevalence of psychiatric comorbidities, namely depression and adjustment disorder in patients with IMI. Besides, alcohol consumption is a prevalent but not adequately treated condition in UMI group.

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“…This poisoning generally occurs either intentionally through abuse or attempted suicide or unintentionally through misuse or accident [4,5]. It is a medical emergency in which the rapid administration of antidotes preventing formic acid formation as a toxic metabolite of methanol by blocking alcohol dehydrogenase (ADH) and the enhanced elimination of formate and methanol are crucial for successful treatment [6][7][8].…”

mentioning

confidence: 99%

Is the Measurement of Serum Formate Concentration Useful in the Diagnostics of Acute Methanol Poisoning? A Prospective Study of 38 Patients

Zakharov

Kurcová

Navrátil

et al. 2014

Basic Clin Pharma Tox

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The aim of this article was to study the role of serum formate (S-formate) in diagnosing methanol poisoning. A prospective study was undertaken of 38 patients from the Czech methanol mass poisoning in 2012 -median age 51 [interquartile range (IQR) 37-62] years with confirmed methanol poisoning. S-formate was measured enzymatically. The receiver operating characteristics (ROC) curve was used to examine the predictive ability of S-formate. Asymptomatic patients had median S-formate of 1.9 (IQR 1.5-2.4) mmol/L. The median S-formate was 15.2 (IQR 13.9-17.6) mmol/L in symptomatic subjects with visual disturbances, 15.4 (12.1-18.0) mmol/L in subjects with dyspnoea and 15.7 (IQR 12.8-18.5) mmol/L in comatose patients. The differences in serum formate concentrations in symptomatic patients depending on clinical features were not significant (all p > 0.05). Patients with long-term visual sequelae of poisoning had median S-formate of 16.1 ) mmol/L; with central nervous system (CNS) sequelae, patients had 15.9 (IQR 14.2-19.5) mmol/L. In lethal cases, the median S-formate was 15.2 (IQR 13.8-15.9) mmol/L. The probability of a poor outcome (death or survival with sequelae) was higher than 90% in patients with S-formate ≥17.5 mmol/L, S-lactate ≥7.0 mmol/L and/or pH <6.87. The ROC analysis showed that the corresponding areas under the curve (AUC) were 0.64 (0.44-0.85 CI 95%) for S-formate, 0.75 (0.56-0.93 CI 95%) for 'S-formate+S-lactate' and only 0.54 (0.38-0.69 CI 95%) for serum methanol, which is lower than for S-formate (p < 0.05). The measurement of S-formate is an important tool in the laboratory diagnostics and clinical management of acute methanol poisoning. S-formate ≥3.7 mmol/L can lead to the first clinical signs of visual toxicity, indicating haemodialysis. S-formate ≥11-12 mmol/L is associated with visual/CNS sequelae and a lethal outcome.Acute methanol poisoning remains a challenge for healthcare providers throughout the world because of its high mortality rate and serious health sequelae [1][2][3]. This poisoning generally occurs either intentionally through abuse or attempted suicide or unintentionally through misuse or accident [4,5]. It is a medical emergency in which the rapid administration of antidotes preventing formic acid formation as a toxic metabolite of methanol by blocking alcohol dehydrogenase (ADH) and the enhanced elimination of formate and methanol are crucial for successful treatment [6][7][8].Nevertheless, in cases of poisoning with toxic spirits containing mixtures of methanol and ethanol in adulterated strong alcoholic beverages, timely diagnosis is difficult due to the long latency period and late presentation to hospitals. Therefore, the onset of treatment is often delayed [7,9]. Serum concentrations of methanol in late-presenting patients can be low and even under the level of detection due to its biotransformation. On the other hand, serum concentrations of formic acid rise high above the upper reference limit of 0.4 mmol/L [9].Formate is one of the normal intermediates in human...

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Suicide attempt using pure methanol with hospitalization of the patient soon after ingestion: case report

Cited by 15 publications

References 5 publications

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non‐Haemorrhagic Brain Lesions

<p>Psychiatric comorbidities in patients with intentional methanol intoxication</p>

Is the Measurement of Serum Formate Concentration Useful in the Diagnostics of Acute Methanol Poisoning? A Prospective Study of 38 Patients

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