Treatment of acute methanol intoxication with hemodialysis using an ethanol-enriched, bicarbonate-based dialysate

Chow, May T.; Silvestro, Vincent A. Di; Yung, Chi Wah; Nawab, Zeenat M.; Leehey, David J.; Ing, Todd S.

doi:10.1016/s0272-6386(97)90318-8

Cited by 30 publications

(29 citation statements)

References 9 publications

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“…Similarly to the alcohol-dehydrogenase blockade induced by ethanol and fomepizole, HD is useful in accelerating the clearance of methanol and ethylene glycol, as well as that of their toxic metabolites, correcting metabolic acidosis and reducing sequelae in target organs and mortality associated with those poisonings. 15 Changes in the constitution of the dialysate, including an ethanol-enriched, bicarbonate-based solution, have been reported as a treatment for acute methanol intoxication. 15 Hemodialysis also increases substantially the elimination rate of isopropanol, salicylates, theophylline, and lithium, although data about clinical outcomes are scarse.…”

Section: Discussionmentioning

confidence: 99%

“…15 Changes in the constitution of the dialysate, including an ethanol-enriched, bicarbonate-based solution, have been reported as a treatment for acute methanol intoxication. 15 Hemodialysis also increases substantially the elimination rate of isopropanol, salicylates, theophylline, and lithium, although data about clinical outcomes are scarse. 14,16 Although the toxicity and pharmacokinetic properties of a drug determine whether those procedures are indicated in severe poisonings, in certain situations, toxicokinetics is different from pharmacokinetics at therapeutic levels.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence of clinical efficacy for HP is based on favorable pharmacokinetic data, studies with animals, anecdotic case reports, case series, and retrospective non-controlled studies comparing HP with support care for poisonings due to a diversity of drugs. [11][12][13][14][15][16][17][18][19][20] However, they do not allow a strong conclusion about the relative efficacy of several management strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Intermittent therapy for poisoned patients usually lasts four to eight hours, but should be defined by the clinical response, the serum concentrations of drugs, and the method applied. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In certain poisonings and specific populations (such as carbamazepine in pediatric patients), high-flow HD can be as efficient as HP without the drawbacks of thrombocytopenia, coagulopathy, hypothermia, and hypocalcemia of the latter. 14 In the present study, only intermittent methods were used.…”

Section: Discussionmentioning

confidence: 99%

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O nefrologista como consultor ante a intoxicação aguda: epidemiologia das intoxicações graves no Rio Grande do Sul e métodos de aumento da depuração renal

Pedroso

Silva²

2010

J. Bras. Nefrol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

O nefrologista como consultor ante a intoxicação aguda: epidemiologia das intoxicações graves no Rio Grande do Sul e métodos de aumento da depuração renal

Pedroso

Silva²

2010

J. Bras. Nefrol.

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“…The role of extracorporeal treatments (ECTRs) in the management of methanol poisoning is well established, [12][13][14][15] although there is ongoing discussion regarding indications. [16,17] ECTRs effectively eliminate both methanol and formate.…”

Section: Importancementioning

confidence: 99%

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

Zakharov

Pelclová

Navrátil

et al. 2016

Clinical Toxicology

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Context: Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formateinduced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined. Objective: We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning. Methods: The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO 3 -, 0.01 unit arterial blood pH, and the total time for correction of HCO 3 -were determined in IHD-and CRRT-treated patients. Results: Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p ¼ 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO 3 -correction correlated with arterial blood pH (r¼ À0.511; p ¼ 0.003) and creatinine (r ¼ 0.415; p ¼ 0.020). There was association between the time to HCO 3 -correction and dialysate/effluent and blood flow rates (r¼ À0.738; p < 0.001 and r¼ À0.602; p < 0.001, correspondingly). The mean time for HCO 3 -to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p ¼ 0.024). The mean increase in HCO 3 -was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001). Conclusions: Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction. ARTICLE HISTORY

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Outcomes of Severe Methanol Intoxication Treated with Hemodialysis: Report of Seven Cases and Review of Literature

Spalding

Briones

Tzamaloukas

2002

Hemodialysis International

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T o identify factors associated with the outcome of severe methanol intoxication treated with hemodialysis, we analyzed the clinical course of 7 patients admitted with serum methanol level higher than 50 mg/dL, and therefore requiring hemodialysis. Four patients (group A) had adverse outcomes (1 death, 3 severe neurological deficits and/or blindness) and 3 patients (group B) had no adverse outcomes. Compared to group B, group A appeared to have a longer delay between ingestion of methanol and arrival at the emergency department (ED), a longer wait in the ED until ethanol infusion was started (3.6 ± 2.7 vs 1.3 ± 0.9 hr, p < 0.05), and, on admission, higher serum methanol (504 ± 219 vs 321 ± 228 mg/dL, p < 0.05), higher serum osmolality (460.5 ± 98.2 vs 397.6 ± 52.3 mOsm/kg, p < 0.05), higher serum osmolal gap (162.6 ± 76.7 vs 105.6 ± 52.9 mOsm/kg, p < 0.05), lower arterial pH (6.86 ± 0.08 vs 7.38 ± 0.16, p < 0.01), lower serum bicarbonate (4.6 ± 1.6 vs 19.9 ± 5.7 mmol/L, p < 0.01), and higher serum anion gap (36.5 ± 1.3 vs 14.3 ± 6.7 mEq/L, p < 0.01). Delay in the ED until hemodialysis was started did not differ (group A 6.4 ± 2.6 hr, group B 5.3 ± 3.5 hr), while duration of hemodialysis until serum methanol levels became permanently undetectable was longer in group A (15.0 ± 0.5 vs 8.4 ± 4.4 hr, p < 0.01). The ingested dose of methanol and the delay between ingestion and initiation of therapy to block methanol metabolism (ethanol infusion) and remove methanol from the body (hemodialysis) appear to be the critical factors influencing the outcome of methanol intoxication. Early diagnosis and initiation of treatment before substantial parts of the ingested methanol have been metabolized are of paramount importance in ensuring a favorable outcome.

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Treatment of acute methanol intoxication with hemodialysis using an ethanol-enriched, bicarbonate-based dialysate

Cited by 30 publications

References 9 publications

O nefrologista como consultor ante a intoxicação aguda: epidemiologia das intoxicações graves no Rio Grande do Sul e métodos de aumento da depuração renal

O nefrologista como consultor ante a intoxicação aguda: epidemiologia das intoxicações graves no Rio Grande do Sul e métodos de aumento da depuração renal

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

Outcomes of Severe Methanol Intoxication Treated with Hemodialysis: Report of Seven Cases and Review of Literature

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