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Original Article Clinical Features, Treatment, and Prognosis of Acute Methanol Poisoning: Experiences in an Outbreak

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Original Article Clinical Features, Treatment, and Prognosis of Acute Methanol Poisoning: Experiences in an Outbreak Int J Clin Exp Med 2019;12(5):5938-5950 www.ijcem.com /ISSN:1940-5901/IJCEM0085245 Original Article Clinical features, treatment, and prognosis of acute methanol poisoning: experiences in an outbreak Maoxia Ran, Ying Li, Liling Zhang, Weihua Wu, Jiaru Lin, Qi Liu, Santao Ou Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China Received September 8, 2018; Accepted February 12, 2019; Epub May 15, 2019; Published May 30, 2019 Abstract: Aims: The aim of this study was to examine the clinical features of acute methanol poisoning to better understand its pathophysiology. Methods: A retrospective study was performed in 52 patients with acute methanol poisoning. Patient characteristics and test results were collected and analyzed. Results: A total of 52 patients, rang- ing from 20-79 years of age, consumed between 5 and 500 mL of alcohol-based fuel, equivalent to 3.3-329.5 g of methanol. Of the 52 patients, 49 were discharged without sequelae, one patient experienced decreased visual acuity, and two patients died after comprehensive treatment. Central nervous system (CNS) disorders, visual distur- bances, and gastrointestinal symptoms were found in 46 (88%), 20 (38%), and 34 (65%) patients upon admission, respectively. Univariate analysis showed that coma, dyspnea, pH, and anion gap (AG), along with calcium, potas- sium, creatinine, and blood sugar levels, were correlated with severity of methanol poisoning and associated with poor patient outcomes. Conclusion: Acute oral methanol poisoning can lead to nerve damage, metabolic acidosis, and gastrointestinal injuries. Most patients recovered after timely and effective comprehensive treatment. Keywords: Methanol poisoning, methanol toxicity, clinical features, prognosis Introduction 5,000 acute cases of toxicity and more than 2,000 associated deaths [10]. Outbreaks often Methanol, also known as the wood alcohol or arise from the consumption of ethanol adulter- Columbian spirit, is a colorless liquid with a ated with methanol (i.e., methylated spirits) taste and smell similar to that of ethanol [1]. [11]. In addition, several recent examples of While methanol poisoning has been associated methanol poisoning have been linked to occu- with ingestion, methanol exposure also occurs pational exposure [12]. In rare cases, methanol by inhalation and skin absorption. After being may be used for attempted suicide. There have rapidly absorbed, methanol is oxidized, conve- been several instances of accidental transder- rted to formaldehyde by alcohol dehydrogena- mal exposure [13-15]. In China, acute methanol se, and subsequently metabolized into formic poisoning most commonly results from the acid by aldehyde dehydrogenase in the liver [2]. excessive consumption of liquor contaminated It is a formic acid metabolite that is highly toxic with methanol. to humans, as it functions as an inhibitor of mitochondrial cytochrome oxidase [3]. Formic In addition to metabolic acidosis, methanol in- acid is a weak inhibitor compared to cyanide, toxication leads to central nervous system but it is strong enough to cause metabolic (CNS) depression, cardiovascular disease, vi- acidosis. sual disturbances, putamina hemorrhages, and even death. It has been reported that mortality Incidence of methanol poisoning has been ris- rates for methanol poisoning range from 10 to ing, worldwide, with a number of outbreaks oc- 50% [6-9]. Previously, the rates of long-term curring in the Czech Republic, Estonia, Iran, Ke- visual sequelae and total sequelae (both vision nya, Khartoum, Libya, Norway, and other coun- and CNS) after methanol poisoning were 25- tries [4-9]. From 2000-2012, there were more 40% and 18-40%, respectively [7, 16]. When than 50 mass outbreaks of methanol pois- treatment is delayed or inadequate, the mor- oning, worldwide, resulting in approximately tality rate increases to more than 40% and Outcomes of methanol poisoning in patients Figure 1. Classification and outcomes of patients with methanol poisoning. many of these patients will experience serious comfort from having mistakenly consumed dif- long-term visual and CNS impairment [17-19]. ferent quantities of alcohol-based fuel on the Fomepizole, an alcohol dehydrogenase inhibi- day of admission or up to two days prior to tor, is an effective antidote for methanol poi- admission. Diagnostic and degree criteria were soning. However, this medication is currently based on the National Occupational Health unavailable in China. The mortality rate is 3.3% Standards of the People’s Republic of China for those patients effectively treated, suggest- and related research [21]: (1) The observation ing there is still room for improvement concern- group included the following: 1) A history of ing therapies available for methanol intoxica- public poisoning; 2) Epidemiologic evidence of tion [20]. Currently, early diagnosis and rapid a history of drinking alcohol-based fuel contain- therapeutic intervention are essential steps for ing a very high concentration of methanol after successfully treating methanol poisoning in pa- toxicological identification; and 3) Patients we- tients. However, late onset of clinical symptoms re asymptomatic or felt some discomfort, such often delays diagnosis. In addition, some hospi- as a headache, dizziness, decreased strength, tals located in rural areas do not have direct blurred vision, nausea, vomiting, abdominal pa- access to the equipment required for methanol in, and diarrhea, yet recovered in a short time; testing. This can also delay diagnosis and effec- (2) Mild acute intoxication (mild group) included tive treatment planning for some patients. cases that complied with observation case diagnostic criteria, in addition to one of the fol- In the current study, clinical data were collected lowing: 1) Mild disorder of consciousness; 2) and summarized from 52 patients treated for Optic disc congestion or edema, retinal edema, methanol poisoning. The aim was to better un- or black spots in the visual field; and 3) Mild derstand the pathophysiology and provide a metabolic acidosis; (3) Severe acute intoxica- basis for clinical diagnosis and treatment. All tion cases (severe group) included one of the patients suffered acute methanol poisoning following symptoms: 1) Serious disorder of con- resulting from the ingestion of alcohol-based sciousness; 2) A sharp decline in visual acuity, fuel, which was mistakenly served as ethanol at optic atrophy, and blindness; and 3) Serious a party on February 3-4, 2017. metabolic acidosis. Diagnoses were confirmed Materials and methods by three or more physicians. Patients Patients were then divided into three groups, in accordance with the severity of methanol poi- Patients with methanol poisoning were includ- soning: 30 cases of observation-only, 17 cases ed in this study (Figure 1). All patients felt dis- of mild acute intoxication patients, and 5 cases 5939 Int J Clin Exp Med 2019;12(5):5938-5950 Outcomes of methanol poisoning in patients of severe acute intoxication (Figure 1). Medical including treatment to protect the organs, ma- histories of the patients in this study included a intain electrolyte balance, and reduce risks of history of previous surgeries (n = 10), hepatitis infection, along with consciousness-promoting (n = 3), and lung disease (n = 2). One patient drugs and others. Endotracheal intubation and each had hypertension, coronary heart disea- mechanical ventilation were used in severe se, cerebral infarction, or cataracts. The rem- cases, as required, with enhanced monitoring aining 34 patients had no prior medical history and nursing. Other treatment options are avail- to report. able but they were not used in this study. For example, gastrolavage was not conducted in Collection of patient data this study due to the length of time between the ingestion of methanol and hospital admission. Patient data, including demographics, general Also, fomepizole and ethanol, which can inhibit information, and test results, were collected the alcohol dehydrogenase (ADH) enzyme, were via an electronic medical history system. Data not administered to patients in this study, as included hematological and biochemical test- they are not yet approved in China. ing, vision testing, stereoscopic fundus exami- nation, visual evoked potential (VEP) testing, Statistical analysis electrocardiogram (ECG), computed tomogra- phy (CT) imaging, and abdominal ultrasound All statistical analyses were performed using (US) imaging. Written informed consent was SPSS Version 23.0 (IBM, Chicago, IL, USA). Da- obtained from patients or families and patients ta are expressed as median with a range and did not experience increased pain or hospital- mean ± standard deviation (mean ± SD), as ization costs due to the study. The remaining appropriate. For comparisons of quantitative alcohol-based fuel was sent to the National data between groups, common statistical tests Supervision and Inspection Center of Liquor were employed, such as t-test, one-way analy- and Processed Food Quality for analysis. In the sis of variance (ANOVA), Kruskal-Wallis H-test, fuel, the detected methanol concentration was and Mann-Whitney U-test. Chi-squared test and 659 g/L. Fisher’s exact test were used for qualitative data. Correlation analyses between two vari- Treatments ances were conducted using Spearman’s rank correlation analysis. P-values less than 0.05 Treatment protocols were formulated via dis- are considered statistically significant. cussion by a multidisciplinary
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