The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014

Rostrup, Morten; Edwards, Jeffrey K.; Abukalish, Mohamed; Ezzabi, Masoud; Some, David; Ritter, H; Menge, Tom; Abdelrahman, A. O.; Rootwelt, Rebecca; Janssens, Bart; Lind, Kyrre; Paasma, Raido; Hovda, Knut Erik

doi:10.1371/journal.pone.0152676

Cited by 82 publications

(78 citation statements)

References 15 publications

(33 reference statements)

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“…The practice has led directly to the deaths of several Australians from methanol poisoning, both locally and in Indonesia . Methanol poisoning outbreaks also continue to occur, particularly in developing countries where resource limitations contribute to high morbidity and mortality, most recently seen in the Czech Republic (2012), Libya (2013) and Kenya (2014) . Clinician awareness is essential for early diagnosis and requires a thorough history of potential exposure sources.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Methanol poisoning outbreaks also continue to occur, particularly in developing countries where resource limitations contribute to high morbidity and mortality, most recently seen in the Czech Republic (2012), Libya (2013) and Kenya (2014). 4,5 Clinician awareness is essential for early diagnosis and requires a thorough history of potential exposure sources. Direct ingestion is responsible for most cases of methanol poisoning; however, toxicity through inhalation exposure can also occur.…”

Section: Discussionmentioning

confidence: 99%

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Severe methanol poisoning with neurological sequelae: implications for diagnosis and management

Holt

Nickson

2018

Internal Medicine Journal

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A 22-year-old woman presented with methanol toxicity manifesting as headache, reduced conscious state and visual change after consuming home-made grappa. She progressed to a coma with fixed mydriasis and severe acidaemia (pH 6.55). She was treated with empirical antidote administration (intravenous ethanol) and enhanced elimination through haemodialysis. She survived despite her delayed presentation but developed significant neurological sequelae, including visual impairment. We provide an overview of key elements of diagnosis and recent updates in treatment recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe methanol poisoning with neurological sequelae: implications for diagnosis and management

Holt

Nickson

2018

Internal Medicine Journal

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“…Acute methanol poisonings occur frequently either in clusters or as mass “epidemics,” representing a challenge for healthcare providers throughout the world [1–4]. Treatment consists of a buffer to correct acidemia, antidote (ethanol or fomepizole) to block the metabolism of methanol, folate substitution to enhance the endogenous metabolism of formate, and dialysis to eliminate methanol and its toxic metabolite [5–7].…”

Section: Introductionmentioning

confidence: 99%

Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks

Zakharov

Rulíšek

Nurieva

et al. 2017

Ann. Intensive Care

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BackgroundIntermittent hemodialysis (IHD) is the modality of choice in the extracorporeal treatment (ECTR) of acute methanol poisoning. However, the comparative clinical effectiveness of intermittent versus continuous modalities (CRRT) is unknown. During an outbreak of mass methanol poisoning, we therefore studied the effect of IHD versus CRRT on mortality and the prevalence of visual/central nervous system (CNS) sequelae in survivors.MethodsThe study was designed as prospective observational cohort study. Patients hospitalized with a diagnosis of acute methanol poisoning were identified for the study. Exploratory factor analysis and multivariate logistic regression were applied to determine the effect of ECTR modality on the outcome.ResultsData were obtained from 41 patients treated with IHD and 40 patients with CRRT. The follow-up time in survivors was two years. Both groups of patients were comparable by age, time to presentation, laboratory data, clinical features, and other treatment applied. The CRRT group was more acidemic (arterial blood pH 6.96 ± 0.08 vs. 7.17 ± 0.07; p < 0.001) and more severely poisoned (25/40 vs. 9/41 patients with Glasgow Coma Scale (GCS) ≤ 8; p < 0.001). The median intensive care unit length of stay (4 (range 1–16) days vs. 4 (1–22) days; p = 0.703) and the number of patients with complications during the treatment (11/41 vs. 13/40 patients; p = 0.576) did not differ between the groups. The mortality was higher in the CRRT group (15/40 vs. 5/41; p = 0.008). The number of survivors without sequelae of poisoning was higher in the IHD group (23/41 vs. 10/40; p = 0.004). There was a significant association of ECTR modality with both mortality and the number of survivors with visual and CNS sequelae of poisoning, but this association was not present after adjustment for arterial blood pH and GCS on admission (all p > 0.05).ConclusionsIn spite of the faster correction of the acidosis and the quicker removal of the toxic metabolite in intermittent dialysis, we did not find significant differences in the treatment outcomes between the two groups after adjusting for the degree of acidemia and the severity of poisoning on admission. These findings support the strategy of “use what you have” in situations with large outbreaks and limited dialysis capacity.

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“…There have been numerous outbreaks in recent years, with the highest frequency in developing countries. Outbreaks with several hundred victims have been reported, some with over 60% fatalities . With the most recent outbreaks in Libya 2013 and Kenya 2014, Doctors without Borders/Médecins Sans Frontières (MSF) evaluated the global problem of methanol poisoning , as also emphasized in recent publications .…”

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confidence: 99%

The Hypothesis of Circulus Hypoxicus and Its Clinical Relevance in Patients With Methanol Poisoning – An Observational Study of 35 Patients

Drangsholt

Vangstad

Zakharov

et al. 2018

Basic Clin Pharma Tox

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Methanol mass poisoning is a global problem with high fatality rates and often severe sequelae in survivors. Patients typically present late to the hospital with severe metabolic acidosis followed by a rapid deterioration in their clinical status. The hypothesis 'Circulus hypoxicus' describes the metabolic acidosis following methanol poisoning as a self-enhancing hypoxic circle responsible for methanol toxicity. We wanted to test the validity of this hypothesis by an observational study based on 35 patients from the methanol outbreaks in Norway (2004) and the Czech Republic (2012). Comprehensive laboratory values, including S(serum)-methanol, S-formate, S-lactate, arterial blood gases, anion and osmolal gaps, were used in the calculations. Laboratory values and calculated gaps were compared to each other using linear regression. S-lactate and S-formate correlated better with the increased base deficit and anion gap than did S-formate alone. Base deficit rose to about 20 mmol/L and S-formate rose to 12 mmol/L prior to a significant rise in S-lactate - most likely caused by formate inhibition of mitochondrial respiration (type B lactacidosis). The further rise in S-lactate was not linear to S-formate most likely due to the self-enhancing pathophysiology, but may also be associated with hypotension in critically ill patients and variable ethanol drinking habits. Our study suggests that the primary metabolic acidosis leads to a secondary lactic acidosis mainly due to the toxic effects of formate. The following decline in pH will further increase this toxicity. As such, a vicious and self-enhancing acidotic circle may explain the pathophysiology in methanol poisoning, namely the 'Circulus hypoxicus'.

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The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014

Cited by 82 publications

References 15 publications

Severe methanol poisoning with neurological sequelae: implications for diagnosis and management

Severe methanol poisoning with neurological sequelae: implications for diagnosis and management

Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks

The Hypothesis of Circulus Hypoxicus and Its Clinical Relevance in Patients With Methanol Poisoning – An Observational Study of 35 Patients

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