Metil Alkol Zehirlenmeleri

Year 2022, , 37 - 42, 09.03.2022

Ömer Taşkın , Ayça Açıkalın , Rana Dişel

https://doi.org/10.54996/anatolianjem.1080055

Abstract

Tüm dünyada, metil alkole bağlı toksik felaketler, ara ara epidemi şeklinde pek çok ölüme sebebiyet vermiştir. Ülkemizde de, dönem dönem, düşük maliyetli içki elde edebilmek için yapılan, yasadışı içeceklerin tüketilmesine bağlı metil alkol zehirlenmesi vakalarına, acil servislerde maalesef giderek artan sıklıkta rastlanılmaktadır. Tedavide, hastaların erken acil başvurusunun yanında, sıradan bir etil alkol alımı nedeniyle başvuran diğer hastalardan ayırımı, yani erken tanısı, oldukça önemlidir. Bu parametrelerin yanısıra hastanın etkin tedavi edilebilmesi için, hemodiyaliz gibi kaynaklara acil ulaşım da tedavinin kilit taşını oluşturmaktadır.
Bu nedenle yazımızda, metil alkol zehirlenmelerinin acil servislerde erken tespiti, ayırıcı tanısı, antidot tedavisi, hemodiyaliz endikasyonları ve bu konudaki kaynaklarımızın yeterliliği güncel literatür eşliğinde tartışılacaktır.

Keywords

Metil alkol, hemodiyaliz, fomepizol, metabolik asidoz

Methyl Alcohol Intoxications

Abstract

All over the world, toxic disasters related to methyl alcohol have caused many deaths in the form of occasional epidemics. In our country, cases of methyl alcohol poisoning due to the consumption of illegal beverages, which are made to obtain low-cost drinks from time to time, are encountered with an increasing frequency in emergency services. In the treatment, besides the early emergency admission of the patients, it is very important to distinguish them from the other patients who apply for an ordinary ethyl alcohol intake, in other words, early diagnosis. In addition to these parameters, emergency access to resources such as hemodialysis is the keystone of treatment for the patient to be treated effectively.
We aim to discuss the clinical findings and treatment methods of this poisoning, in which early diagnosis and treatment are life-saving, in the light of current literature.

Keywords

Methyl alcohol, hemodialysis, fomepizole, metabolic acidosis

References

• Ott J, Gronemann V, Pontzen F, et al. encyclopedia of industrial, 2000 undefined. Methanol. ugr.es. doi:10.1002/14356007.a16_465.pub3
• Gómez Perera S, Rodríguez Talavera I, Tapia Quijada HE, et al. Secondary visual loss due to inhalation and cutaneous poisoning by methanol and toluene. Presentation of a clinical case. Archivos de la Sociedad Espanola de Oftalmologia. 2020;95(5):231-235. doi:10.1016/J.OFTAL.2020.02.004
• Robledo C, Saracho R. Methanol poisoning by solvent inhalation. Nefrologia. 2018;38(6):679-680. doi:10.1016/J.NEFRO.2018.03.005
• Pohanka M. Toxicology and the biological role of methanol and ethanol: Current view. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2016;160(1):54-63. doi:10.5507/BP.2015.023
• Vale A. Methanol. Medicine. 2007;35(12):633-634. doi:10.1016/J.MPMED.2007.09.014
• Mégarbane B. Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open Access Emergency Medicine : OAEM. 2010;2:67. doi:10.2147/OAEM.S5346
• Liesivuori J, Savolainen AH. Methanol and formic acid toxicity: biochemical mechanisms. Pharmacology & toxicology. 1991;69(3):157-163. doi:10.1111/J.1600-0773.1991.TB01290.X
• Kruse JA. Methanol and ethylene glycol intoxication. Critical care clinics. 2012;28(4):661-711. doi:10.1016/J.CCC.2012.07.002
• Hovda KE, Gadeholt G, Evtodienko V, et al. A novel bedside diagnostic test for methanol poisoning using dry chemistry for formate. Scandinavian journal of clinical and laboratory investigation. 2015;75(7):610-614. doi:10.3109/00365513.2015.1066847
• Hovda KE, Lao YE, Gadeholt G, et al. Formate test for bedside diagnosis of methanol poisoning. Basic & clinical pharmacology & toxicology. 2021;129(1):86-88. doi:10.1111/BCPT.13597
• Kraut JA, Kurtz I. Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management. Clinical Journal of the American Society of Nephrology. 2008;3(1):208-225. doi:10.2215/CJN.03220807
• Gallagher N, Edwards FJ. The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Advanced Journal of Emergency Medicine. 2019;3(3):28. doi:10.22114/AJEM.V0I0.153
• Taheri MS, Moghaddam HH, Moharamzad Y, et al. The value of brain CT findings in acute methanol toxicity. European journal of radiology. 2010;73(2):211-214. doi:10.1016/J.EJRAD.2008.11.006
• Jain N, Himanshu D, Verma SP, et al. Methanol poisoning: characteristic MRI findings. Annals of Saudi medicine. 2013;33(1):68-69. doi:10.5144/0256-4947.2012.26.5.1114
• Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, Jacobsen D. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study. Clin Toxicol (Phila). 2012 Nov;50(9):823-31. doi: 10.3109/15563650.2012.728224.
• McMahon DM, Winstead S, Weant KA. Toxic alcohol ingestions: Focus on ethylene glycol and methanol. Advanced Emergency Nursing Journal. 2009;31(3):206-213. doi:10.1097/TME.0b013e3181ad8be8
• Newman N, Biousse V. Diagnostic approach to vision loss. CONTINUUM Lifelong Learning in Neurology. 2014;20(4):785-815. doi:10.1212/01.CON.0000453317.67637.46
• Chung TN, Kim SW, Park YS, et al. Unilateral blindness with third cranial nerve palsy and abnormal enhancement of extraocular muscles on magnetic resonance imaging of orbit after the ingestion of methanol. Emergency medicine journal : EMJ. 2010;27(5):409-410. doi:10.1136/EMJ.2009.084277
• Treichel JL, Murray TG, Lewandowski MF, et al. Retinal toxicity in methanol poisoning. Retina. 2004;24(2):309-312. doi:10.1097/00006982-200404000-00023
• Ariwodola O, Neuroscience JWJ of, 2004 undefined. Ethanol potentiation of GABAergic synaptic transmission may be self-limiting: role of presynaptic GABAB receptors. Soc Neuroscience. Published online 2004. doi:10.1523/JNEUROSCI.1768-04.2004
• Symington L, Jackson L, Klaassen B. Toxic alcohol but not intoxicated - A case report. Scottish Medical Journal. 2005;50(3):129-130. doi:10.1177/003693300505000314
• McLean DR, Jacobs H, Mielke BW. Methanol poisoning: A clinical and pathological study. Annals of Neurology. 1980;8(2):161-167. doi:10.1002/ANA.410080206
• Elwell RJ, Darouian P, Bailie GR, et al. Delayed absorption and postdialysis rebound in a case of acute methanol poisoning. The American Journal of Emergency Medicine. 2004;22(2):126-127. doi:10.1016/J.AJEM.2003.12.017
• Hovda KE, Jacobsen D. Expert opinion: fomepizole may ameliorate the need for hemodialysis in methanol poisoning. Human & experimental toxicology. 2008;27(7):539-546. doi:10.1177/0960327108095992
• Mégarbane B. Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open access emergency medicine : OAEM. 2010;2:67-75. doi:10.2147/OAEM.S5346
• Brent J, McMartin K, Phillips S, et al. Fomepizole for the Treatment of Methanol Poisoning. New England Journal of Medicine. 2001;344(6):424-429. doi:10.1056/NEJM200102083440605
• Lepik KJ, Brubacher JR, DeWitt CR, et al. Bradycardia and hypotension associated with fomepizole infusion during hemodialysis. Clinical Toxicology. 2008;46(6):570-573. doi:10.1080/15563650701725128
• Methanol and ethylene glycol poisoning: Management - UpToDate. Accessed February 10, 2022. https://www.uptodate.com/contents/methanol-and-ethylene-glycol-poisoning-management?search=methanol%20poisoning&source=search_result&selectedTitle=2~40&usage_type=default&display_rank=2#H4284666786
• Elenhorn J.M, Schonwald S, Ordog G, et al. Elenhorn’s Medical Toxicology. Second Edition.
• Naraqi S, Dethlefs RF, Slobodniuk RA, et al. An Outbreak of Acute Methyl Alcohol Intoxication. Australian and New Zealand Journal of Medicine. 1979;9(1):65-68. doi:10.1111/J.1445-5994.1979.TB04116.X
• Barceloux DG, Krenzelok EP, Olson K, et al. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee. Journal of toxicology Clinical toxicology. 1999;37(5):537. doi:10.1081/CLT-100102445
• Liesivuori J, Savolainen AH. Methanol and Formic Acid Toxicity: Biochemical Mechanisms. Pharmacology & Toxicology. 1991;69(3):157-163. doi:10.1111/J.1600-0773.1991.TB01290.X
• Shukla M, Shikoh I, Saleem A. Intravenous methylprednisolone could salvage vision in methyl alcohol poisoning [8]. Indian Journal of Ophthalmology. 2006;54(1):68-69. doi:10.4103/0301-4738.21628
• Sodhi PK, Goyal JL, Mehta Ms DK. Methanol-induced optic neuropathy: Treatment with intravenous high dose steroids. International Journal of Clinical Practice. 2001;55(9):599-602.
• Sanaei-Zadeh H. What Are the Therapeutic Effects of High-Dose Intravenous Prednisolone in Methanol-Induced Toxic Optic Neuropathy? https://home.liebertpub.com/jop. 2012;28(4):327-328. doi:10.1089/JOP.2011.0209
• Nekoukar Z, Zakariaei Z, Taghizadeh F, et al. Methanol poisoning as a new world challenge: A review. Annals of medicine and surgery (2012). 2021;66. doi:10.1016/J.AMSU.2021.102445
• Pakdel F, Sanjari MS, Naderi A, et al. Erythropoietin in treatment of methanol optic neuropathy. Journal of Neuro-Ophthalmology. 2018;38(2):167-171. doi:10.1097/WNO.0000000000000614