Useful Electrocardiographic and Laboratory Findings in Shiraz Outbreak of 356 Methanol Poisoned Patients

Abstract

Background: Binge alcohol eating especially in underdeveloped countries may be complicated by methanol toxicity, especially when blinded drunken cases come to emergency department. Unfortunately, in early months of 2020, Fars, one of the largest provinces in southern Iran, reported one of the largest methanol poisoning outbreaks with high case-fatality rate. Here we like to share our experience and introduce some simple measures which may announce more urgent dialysis to save the lives of these patients.Method: In this study, 356 cases with methanol toxicity referred to the Tertiary Hospitals (Faghihi and Namazi) affiliated to Shiraz University of Medical Sciences during March and April, 2020. To collect the required data, clinical findings on blindness and impaired level of consciousness, laboratory data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results: Among the participants, 321 (90.2%) patients were male, and 162 persons (45.5%) were aged below 30 years old. Reviewing the laboratory data of the included patients revealed that PH, HCO3, and O2 saturation decreased. While PCO2, Cr, K, BS increased (P<0.05). In the multiple analysis, when the intervening factors of age and gender were adjusted and all ECG items were included in the model, T slope>=70, Brugada pattern, low voltage QRS, severe metabolic acidosis (PH<7.2) and lack of hyperventilation when severely acidotic showed independent relationship with mortality with the odds ratios of 3.42, 5.65, 6.70, 4.55 and 5.74 respectively.Conclusion: Apart from usual modalities like acidosis, electrolyte imbalance, QTc prolongation and prominent U wave, we found Brugada like ECG, notch in QRS and steeply terminal T wave more than 70 degrees to be ominous signs and need urgent attention.

Methanol poisoning during the COVID‐19 pandemic in Iran: A retrospective cross‐sectional study of clinical, laboratory, and brain imaging characteristics and outcomes

“…Another possible explanation for the normal CT scans in our study is that the cause of death among the deceased patients could be damage to other organ systems, such as cardiac, 27 renal failure, and other organs, 19 rather than brain injury. Therefore, imaging may not be very useful at the early stage of admission.…”

“…Moreover, due to overcrowding in the imaging ward, each patient could only have one CT scan in the early hours or days of admission and could not have a delayed or follow‐up CT scan. Another possible explanation for the normal CT scans in our study is that the cause of death among the deceased patients could be damage to other organ systems, such as cardiac, 27 renal failure, and other organs, 19 rather than brain injury. Therefore, imaging may not be very useful at the early stage of admission.…”