Methanol poisoning: Analysis of a case series in two public hospitals
Keywords:
Poisoning, Methanol, Acidosis
Abstract
Objective: To describe the clinical and epidemiological characteristics of patients with methanol poisoning in two public hospitals.
Materials and methods: Retrospective case series, 41 medical records of patients admitted to emergency with a diagnosis of methanol intoxication in the period 2018-2022 in two public hospitals in Lima-Peru were reviewed. Patients were from Arzobispo Loayza National Hospital and Hipolito Unanue Hospital.
Results: Of the 41 patients, 35 were male, with a mean age of 44.4 years. Nearly 50% were admitted to the intensive care unit (ICU), and 23/41 (56,1%) required hemodialysis. All patients presented severe metabolic acidosis with elevated anion gap. Forty-eight hours after admission, 9/41 (21,9%) patients died. Of those who survived, 23/41 (56,1%) had sequelae: 21 patients developed toxic optic neuropathy and two patients had motor sequelae due to hemorrhagic stroke. Lower pH (6,7 vs. 7,1, p<0,001) and bicarbonate (3 mmol/L vs.
4,9 mmol/L, p= 0,004) levels, as well as higher lactate (9,6 mmol/L vs 2,3 mmol/L, p<0,001) and sodium (142,5 mmol/L vs. 138 mmol/L, p<0,036) values were evidenced in the deceased patients compared to those who survived.
Conclusion: Methanol poisoning continues to be a condition that leaves sequelae and it may lead to death. Severe metabolic acidosis with an elevated anion gap, associated with respiratory and neurological symptoms are its main manifestations; therapy is based on the administration of ethanol, bicarbonate, and hemodialysis support.
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References
1. Yurtsever g, Arikan c, Acar h, Sorgun o, Bora E. Methanol poisoning in the emergency department: a retrospective study. J Heal Sci Med. 2022;5(4):949–53. doi.org/10.32322/jhsm.1095045
2. Eskandrani, R.; Almulhim, K.; Altamimi, A.; Alhaj, A.; Alnasser, S.; Alawi, L.; Aldweikh, E.; Alaufi, K.; Mzahim, B. Brote de intoxicación por metanol en Arabia Saudita: una serie de casos. J. Med. Informe de caso 2022 , 16 , 357. doi:10.1186/s13256-022-03600-7
3. Issa, SY; Galal, AM; Gaber, YM Toxicidad del metanol en la Provincia Oriental: una serie de casos de dilemas de toxicólogos y departamentos de emergencia con una revisión de la literatura. Indian J. Medicina Forense. Toxico. 2022 , 16 , 1743–1758. https://doi.org/10.37506/ijfmt.v16i1.17902
4. Urko B-F, Francisco-Javier G-M, Med Bilbao G, Etanol Putamen Acido fórmico Alcohol Intoxicación M, Etanola Putamena M. Intoxicación por metanol. A propósito de un caso original breve nota clínica palabras clave giltza-hitzak. Gac Med Villahermosa [Internet]. 2022;119(3):162–4. Available from: http://www.gacetamedicabilbao.eus/index.php/gacetamedicabilbao/article/view/909
5. Tomsia M, Głaz M, Nowicka J, Cieśla J, Sosnowski M, Chełmecka E. Fatal Methanol Poisoning Caused by Drinking Industrial Alcohol: Silesia Region, Poland, April–June 2022. Toxics. 2022;10(12). https://doi.org/10.3390/toxics10120800
6. Morteza Bagi, H. R., Tagizadieh, M., Moharamzadeh, P., Pouraghaei, M., Kahvareh Barhagi, A. and Shahsavari Nia, K. Epidemiology of alcohol poisoning and its outcome in the NorthWest of Iran. Emergency (Tehran, Iran). 2015; 3(1):27–32. PMID: 26512366; PMCID: PMC4614612.
7. Villasmil E. Intoxicación aguda por metanol. Reporte de caso. Acute methanol poisoning. Case report. Av en Biomed [Internet]. 2018;7. Available from: https://www.redalyc.org/journal/3313/331367295006/331367295006.pdf
8. Palacio H, Hernández A, Delgado R. Intoxicación Por Alcohol Metílico : A Propósito De Un Caso. Rev Ciencias Médicas la Habana [Internet]. 2013;19(3):3–7. Available from: http://www.medigraphic.com/pdfs/revciemedhab/cmh-2013/cmh133m.pdf
9. Elbastawesy S, Shama M, Elsharkawy A, Helal N. Predictors of Poor Outcomes in Acute Methanol Poisoning. Egypt J Forensic Sci Appl Toxicol. 2022;22(2):57–68. doi: 10.21608/EJFSAT.2021.76747.1198
10. Veras-Estévez BA, Chapman HJ. Methanol Toxicity Outbreaks in the Americas: Strengthening National Prevention and Response Measures. Medicc Rev. 2022;24(2):43–4. https://doi.org/10.37757/mr2022.v24.n2.8
11. Zakharov, S.; Rulisek, J.; Hlusicka, J.; Kotikova, K.; Navratil, T.; Komarc, M.; Vaneckova, M.; Seidl, Z.; Diblik, P.; Bydzovsky, J.; et al. El impacto de las comorbilidades en la supervivencia de 6 años después de un brote de intoxicación masiva por metanol: posible papel del formaldehído metabólico. Clínico. Toxico. 2020 , 58 , 241–253. 10.1080/15563650.2019.1637525
12. Ran M, Li Y, Zhang L, Wu W, Lin J, Liu Q, et al. Original Article Clinical features, treatment, and prognosis of acute methanol poisoning: experiences in an outbreak. Int J Clin Exp Med [Internet]. 2019;12(5):5938–50. Available from: www.ijcem.com/
13. Shadnia, S.; Shojaei Arani, L.; Bahmani, K.; Akhgari, M.; Faraji Dana, H.; Ghadirzadeh, M. Características demográficas y clínicas de los pacientes que murieron por toxicidad del metanol durante el brote de COVID 19 en el Hospital Loghman-e-Hakim de Teherán. En t. J. Med. Toxico. Medicina Forense. 2022 , 12 , 36171. DOI:10.32598/ijmtfm.v12i1.36171
14. Public Health England. Methanol Toxicological Overview Key Points Health effects of chronic exposure. Methanol Toxicol Overv [Internet]. 2015;(August). Available from: https://www.gov.uk/government/publications/methanol-properties-incident-management-and-toxicology
15. Peces R, González E, Peces C, Selgas R. Tratamiento de las intoxicaciones graves por alcoholes. Nefrologia. 2008;28(4):369–72.
16. Roldán J, Frauca C, Dueñas A. Intoxicación por alcoholes Alcohol intoxication. An Sist Sanit Navar. 2003;26:129–39.
17. Valdivia-Infantas M, Intoxicación por metanol en Lima. Rev Soc Peru Med Interna. 2022;35(4). doi: https://doi.org/10.36393/spmi.v35i4.700
18. Quintana E, Rosalia A.Alerta epidemiológica. www.gob.pe/minsa. 2022;(511):29–31.
19. R.D.No 263-2022-DG-HNAL.pdf.pdf. Guía de práctica clínica del manejo de la Intoxicación por metanol. HNAL.2022
20. Kraut J. Approach to the Treatment of Methanol Intoxication.Am J Kidney Dis. 2016;68(1):161-167. doi: 10.1053/j.ajkd.2016.02.058
21. Roberts DM, Yates C, Megarbane B, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med. 2015;43(2):461-472.
22. Hirsch D, Jindal, Wong P, Fraser A. A simple method to estimate the required dialysis time for cases of alcohol poisoning. Kidney international. 2001. 60(5), 2021–2024. https://doi.org/10.1046/j.1523-1755.2001.00003.x
23. Nizhu, L. N., Barua, D., Anam, A. M., Polash, M. M. I., Tun, S. S., Nessa, R. R., et al. (2018): Haemodialysis in Methanol Poisoning. Bangladesh Critical Care Journal, 6(1):23–25.
24. Yousefinejad, V., Moradi, B., Mohammadibaneh, A., Sheikhesmaeili, F., and Babahajian, A. (2020): Prognostic Factors of Outcome in Methanol Poisoning; an 8- year Retrospective Cross-sectional Study. Archives of academic emergency medicine, 8(1):69. PMID: 33134965; PMCID: PMC7587997.
25. Zakharov S, Pelclova D, Diblik P, Urban P, Kutan P, Nurieva O et al. Long-term visual damage after acute methanol poisonings: longitudinal cross-sectionalstudy in 50 patients. Clin Toxicol. 2015; 53:884-892.https://doi.org/10.3109/15563650.2015.1086488
26. Nurieva et al, Diblik P, Kuthan P, Sklenka P, Meliska P, Bydzovsky J et al. Progressive chronic retinal axonal loss following acute methanol-induced optic neuropathy: Four-year prospective cohort study. Am J Ophthalmol. 2018; 191:100–115. https://doi.org/10.1016/j.ajo.2018.04.015.
25. Liberski S, Kaluzny B, Kocięcki B. Methanol induced optic neuropathy: a still present problem. Archives of Toxicology. 2022; 96:431–451. https://doi.org/10.1007/s00204-021-03202-0
2. Eskandrani, R.; Almulhim, K.; Altamimi, A.; Alhaj, A.; Alnasser, S.; Alawi, L.; Aldweikh, E.; Alaufi, K.; Mzahim, B. Brote de intoxicación por metanol en Arabia Saudita: una serie de casos. J. Med. Informe de caso 2022 , 16 , 357. doi:10.1186/s13256-022-03600-7
3. Issa, SY; Galal, AM; Gaber, YM Toxicidad del metanol en la Provincia Oriental: una serie de casos de dilemas de toxicólogos y departamentos de emergencia con una revisión de la literatura. Indian J. Medicina Forense. Toxico. 2022 , 16 , 1743–1758. https://doi.org/10.37506/ijfmt.v16i1.17902
4. Urko B-F, Francisco-Javier G-M, Med Bilbao G, Etanol Putamen Acido fórmico Alcohol Intoxicación M, Etanola Putamena M. Intoxicación por metanol. A propósito de un caso original breve nota clínica palabras clave giltza-hitzak. Gac Med Villahermosa [Internet]. 2022;119(3):162–4. Available from: http://www.gacetamedicabilbao.eus/index.php/gacetamedicabilbao/article/view/909
5. Tomsia M, Głaz M, Nowicka J, Cieśla J, Sosnowski M, Chełmecka E. Fatal Methanol Poisoning Caused by Drinking Industrial Alcohol: Silesia Region, Poland, April–June 2022. Toxics. 2022;10(12). https://doi.org/10.3390/toxics10120800
6. Morteza Bagi, H. R., Tagizadieh, M., Moharamzadeh, P., Pouraghaei, M., Kahvareh Barhagi, A. and Shahsavari Nia, K. Epidemiology of alcohol poisoning and its outcome in the NorthWest of Iran. Emergency (Tehran, Iran). 2015; 3(1):27–32. PMID: 26512366; PMCID: PMC4614612.
7. Villasmil E. Intoxicación aguda por metanol. Reporte de caso. Acute methanol poisoning. Case report. Av en Biomed [Internet]. 2018;7. Available from: https://www.redalyc.org/journal/3313/331367295006/331367295006.pdf
8. Palacio H, Hernández A, Delgado R. Intoxicación Por Alcohol Metílico : A Propósito De Un Caso. Rev Ciencias Médicas la Habana [Internet]. 2013;19(3):3–7. Available from: http://www.medigraphic.com/pdfs/revciemedhab/cmh-2013/cmh133m.pdf
9. Elbastawesy S, Shama M, Elsharkawy A, Helal N. Predictors of Poor Outcomes in Acute Methanol Poisoning. Egypt J Forensic Sci Appl Toxicol. 2022;22(2):57–68. doi: 10.21608/EJFSAT.2021.76747.1198
10. Veras-Estévez BA, Chapman HJ. Methanol Toxicity Outbreaks in the Americas: Strengthening National Prevention and Response Measures. Medicc Rev. 2022;24(2):43–4. https://doi.org/10.37757/mr2022.v24.n2.8
11. Zakharov, S.; Rulisek, J.; Hlusicka, J.; Kotikova, K.; Navratil, T.; Komarc, M.; Vaneckova, M.; Seidl, Z.; Diblik, P.; Bydzovsky, J.; et al. El impacto de las comorbilidades en la supervivencia de 6 años después de un brote de intoxicación masiva por metanol: posible papel del formaldehído metabólico. Clínico. Toxico. 2020 , 58 , 241–253. 10.1080/15563650.2019.1637525
12. Ran M, Li Y, Zhang L, Wu W, Lin J, Liu Q, et al. Original Article Clinical features, treatment, and prognosis of acute methanol poisoning: experiences in an outbreak. Int J Clin Exp Med [Internet]. 2019;12(5):5938–50. Available from: www.ijcem.com/
13. Shadnia, S.; Shojaei Arani, L.; Bahmani, K.; Akhgari, M.; Faraji Dana, H.; Ghadirzadeh, M. Características demográficas y clínicas de los pacientes que murieron por toxicidad del metanol durante el brote de COVID 19 en el Hospital Loghman-e-Hakim de Teherán. En t. J. Med. Toxico. Medicina Forense. 2022 , 12 , 36171. DOI:10.32598/ijmtfm.v12i1.36171
14. Public Health England. Methanol Toxicological Overview Key Points Health effects of chronic exposure. Methanol Toxicol Overv [Internet]. 2015;(August). Available from: https://www.gov.uk/government/publications/methanol-properties-incident-management-and-toxicology
15. Peces R, González E, Peces C, Selgas R. Tratamiento de las intoxicaciones graves por alcoholes. Nefrologia. 2008;28(4):369–72.
16. Roldán J, Frauca C, Dueñas A. Intoxicación por alcoholes Alcohol intoxication. An Sist Sanit Navar. 2003;26:129–39.
17. Valdivia-Infantas M, Intoxicación por metanol en Lima. Rev Soc Peru Med Interna. 2022;35(4). doi: https://doi.org/10.36393/spmi.v35i4.700
18. Quintana E, Rosalia A.Alerta epidemiológica. www.gob.pe/minsa. 2022;(511):29–31.
19. R.D.No 263-2022-DG-HNAL.pdf.pdf. Guía de práctica clínica del manejo de la Intoxicación por metanol. HNAL.2022
20. Kraut J. Approach to the Treatment of Methanol Intoxication.Am J Kidney Dis. 2016;68(1):161-167. doi: 10.1053/j.ajkd.2016.02.058
21. Roberts DM, Yates C, Megarbane B, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med. 2015;43(2):461-472.
22. Hirsch D, Jindal, Wong P, Fraser A. A simple method to estimate the required dialysis time for cases of alcohol poisoning. Kidney international. 2001. 60(5), 2021–2024. https://doi.org/10.1046/j.1523-1755.2001.00003.x
23. Nizhu, L. N., Barua, D., Anam, A. M., Polash, M. M. I., Tun, S. S., Nessa, R. R., et al. (2018): Haemodialysis in Methanol Poisoning. Bangladesh Critical Care Journal, 6(1):23–25.
24. Yousefinejad, V., Moradi, B., Mohammadibaneh, A., Sheikhesmaeili, F., and Babahajian, A. (2020): Prognostic Factors of Outcome in Methanol Poisoning; an 8- year Retrospective Cross-sectional Study. Archives of academic emergency medicine, 8(1):69. PMID: 33134965; PMCID: PMC7587997.
25. Zakharov S, Pelclova D, Diblik P, Urban P, Kutan P, Nurieva O et al. Long-term visual damage after acute methanol poisonings: longitudinal cross-sectionalstudy in 50 patients. Clin Toxicol. 2015; 53:884-892.https://doi.org/10.3109/15563650.2015.1086488
26. Nurieva et al, Diblik P, Kuthan P, Sklenka P, Meliska P, Bydzovsky J et al. Progressive chronic retinal axonal loss following acute methanol-induced optic neuropathy: Four-year prospective cohort study. Am J Ophthalmol. 2018; 191:100–115. https://doi.org/10.1016/j.ajo.2018.04.015.
25. Liberski S, Kaluzny B, Kocięcki B. Methanol induced optic neuropathy: a still present problem. Archives of Toxicology. 2022; 96:431–451. https://doi.org/10.1007/s00204-021-03202-0
Published
2024-03-30
How to Cite
1.
Venegas-Justiniano Y, Rosales-Mendoza K, Enríquez-Almanza B, Valdivia-Infantas M, Barboza-Pastrana A, Hurtado-Aréstegui A. Methanol poisoning: Analysis of a case series in two public hospitals. Acta Med Peru [Internet]. 2024Mar.30 [cited 2024Dec.25];41(1). Available from: http://54.39.98.165/index.php/AMP/article/view/2775
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