Methanol: the threat of intoxication is still there

Česká verzia

Authors: Daniela Pelclová; Sergey Zakharov
Authors place of work: Klinika pracovního lékařství 1. LF UK a VFN v Praze
Published in the journal: Vnitř Lék 2016; 62(7-8): 616-619
Category: Reviews

Summary

Methanol mass poisoning occurs across the world quite frequently, but the complete clinical and laboratory data of the patients are only rarely available. Approximately 138 cases of poisoning were documented in the Czech Republic, 107 patients were hospitalized. Another 31 persons died out of hospital. About 60 % of the hospitalized patients survived intoxication without consequences, one half of the remaining 40 % died and the other half survived with the CNS and/or sight impaired. The Czech study successfully used modern diagnostic methods. A positive effect of the prehospital first aid with an oral antidote has been proven and a comparable effect of ethanol and fomepizole has been reached during hospital therapy. Higher efficiency of intermittent therapy has been determined as compared to continual hemodialysis. No connection was found between cerebral hemorrhage and systemic anticoagulation during hemodialysis. Magnetic resonance imaging revealed brain lesions in more than 50 % of the examined persons. During the follow-up visits over months and years improvement regarding the damage to the optic nerve was found in patients with a lesion of mild to medium degree. Isolated cases of poisoning still occur.

Key words:
antidote – long-term follow-up – hemodialysis – methanol – methanol intoxication – CNS damage – vision impairment

Zdroje

1. Barceloux DG, Bond GR, Krenzelok EP et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol 2002; 40(40): 415–446.

2. Olson K, Anderson IB, Benowitz NL et al. Poisoning & Drug Overdose. 6th ed. McGraw-Hill Education (USA) 2011. ISBN 978–0071668330.

3. Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med 2009; 360(21): 2216–2223.

4. Hovda KE, Andersson KS, Urdal P et al. Methanol and formate kinetics during treatment with fomepizole. Clin Toxicol 2005; 43(4): 221–227.

5. Hovda KE, Urdal P, Jacobsen D. Increased serum formate in the diagnosis of methanol poisoning. J Anal Toxicol 2005; 29(6): 586–588.

6. Hovda KE, Hunderi OH, Rudberg N et al. Anion and osmolar gaps in the diagnosis of methanol poisoning: Clinical study in 28 patients. Intensive Care Med 2004; 30(9): 1842–1846.

7. Brent J, McMartin K, Phillips S et al. Fomepizole for the treatment of methanol poisoning. N Engl J Med 2001; 344(6): 424–429.

8. Lepik KJ, Sobolev BG, Levy AR et al. Medication errors associated with the use of ethanol and fomepizole as antidotes for methanol and ethylene glycol poisoning. Clin Toxicol 2011; 49(5): 391–401.

9. Megarbane B, Borron SW, Baud FJ Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med 2005; 31(2): 189–195.

10. Hantson P, Haufroid V, Wallemacq P. Formate kinetics in methanol poisoning. Hum Exp Toxicol 2005; 24(2): 55–59.

11. Paasma R. Clinical study of methanol poisoning: handling large outbreaks, treatment with antidotes, and long-term outcomes. University of Tartu Press: Tartu (Estonia) 2013. ISBN 978–9949–32–376–0 (pdf). Dostupné z WWW: <http://rahvatervis.ut.ee/bitstream/1/5773/1/Paasma2013.pdf>.

12. Paasma R, Hovda KE, Hassanian-Moghaddam H et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes – a multicenter study. Clin Toxicol (Phila) 2012; 50(9): 823–831. Erratum in Clin Toxicol (Phila) 2013; 51(2):125.

13. Hovda KE, Hunderi OH, Tafjord AB et al. Methanol outbreak in Norway 2002–2004: epidemiology, clinical features and prognostic signs. J Intern Med 2005; 258(2): 181–190.

14. Roberts DM, Yates C, Megarbane B et al. [EXTRIP Work Group]. 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.

15. Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae – a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol 2009; 9: 5. Dostupné z DOI: <http://dx.doi.org/10.1186/1472–6904–9-5>.

16. Pelclova D, Zakharov S. Outbreak of methanol poisonings in the Czech Republic in September 2012. EAPCCT News 2012; 8–13.

17. Zakharov S, Navrátil T, Pelclová D et al. Hromadná otrava metanolem v České republice v roce 2012: Srovnání s „metanolovými epidemiemi“ v jiných zemích. Urgentní medicína 2013; 16(2):25–29.

18. Zakharov S, Pelclova D, Urban P et al. Use of Out-of-Hospital Ethanol Administration to Improve Outcome in Mass Methanol Outbreaks. Ann Emerg Med 2016; 68(1): 52–61.

19. Zakharov S, Kurcova I, Navratil T et al. Is the measurement of serum formate concentration useful in the diagnostics of acute methanol poisoning? A prospective study of 38 patients. Basic Clin Pharmacol Toxicol 2015; 116(5): 445–451.

20. Zakharov S, Navratil T, Pelclova D. Fomepizole in the treatment of acute methanol poisonings: experience from the Czech mass methanol outbreak 2012–2013. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158(4): 641–649.

21. Zakharov S, Pelclova D, Navratil T et al. Fomepizole versus ethanol in the treatment of acute methanol poisoning: Comparison of clinical effectiveness in a mass poisoning outbreak. Clin Toxicol (Phila) 2015; 53(8): 797–806.

22. Zakharov S, Navratil T, Salek T et al. Fluctuations in serum ethanol concentration in the treatment of acute methanol poisoning: a prospective study of 21 patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159(4): 666–676.

23. Zakharov S, Pelclova D, Navratil T et al. Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning. Kidney Int 2014; 86(1): 199–207.

24. Zakharov S, Pelclova D, Diblik P et al. Long-term visual damage after acute methanol poisonings: Longitudinal cross-sectional study in 50 patients. Clin Toxicol (Phila) 2015; 53(9): 884–892.

25. Urban P, Zakharov S, Diblík P et al. Visual evoked potentials in patients after methanol poisoning. Int J Occup Med Environ Health 2016; 29(3): 471–478.

26. Bezdicek O, Klempir J, Zakharov S et al. Sequelae of methanol poisoning for cognition. Cesk Slov Neurol 2014; 77(3): 320–325.

27. Vaneckova M, Zakharov S, Klempir J et al. Methanol Intoxication on Magnetic Resonance Imaging. Cesk Slov Neurol 2014; 77(2): 235–239.

28. Vaneckova M, Zakharov S, Klempir J et al. Imaging findings after methanol intoxication (cohort of 46 patients). Neuro Endocrinol Lett 2015; 36(8): 737–744.

29. Zakharov S, Kotikova K, Vaneckova M et al. Acute methanol poisoning: Prevalence and predisposing factors of haemorrhagic and non-haemorrhagic brain lesions. Basic Clin Pharmacol Toxicol 2016; 119(2):228–238.

30. Zakharov S, Pelclova D, Urban P et al. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol (Phila) 2014; 52(10): 1013–1024.