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Usefulness of prolonged haemodialysis in acute methanol poisoning
Utilidad de la hemodiálisis prolongada en el tratamiento de la intoxicación aguda por metanol
Gabriel de Arribaa, Marta Torres-Guineaa, Julio Chevarríaa, Mª Angeles Basterrecheaa
a S. Nefrología, Departamento de Medicina, Hospital Universitario de Guadalalara, Universidad de Alcalá Madrid, Madrid, España,
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    "textoCompleto" => "To the editor&#58; The case of a patient with severe methanol and toluene poisoning has been recently published in <br></br>Nefrolog&#237;a&#46;1 We have treated a patient with severe methanol poisoning and we want to emphasize the importance of prolonged haemodialysis in its treatment&#46; <br></br><br></br>CASE REPORT <br></br><br></br>This was a 40-year-old male patient who was brought into the Emergency Department after suffering frfom severe <br></br>headache&#44; dizziness&#44; irritability and incoherent language&#46; According to the family&#44; the patient had chronic alcoholism although he had not had any alcohol in the last 3 days&#46; In the emergency room&#44; there was deterioration in level of consciousness with progressive coma&#44; so the patient was admitted to the ICU where orotracheal intubation&#44; and mechanical ventilation was used&#46; <br></br><br></br>Laboratory analysis on admission showed an arterial blood gas with a pH of 6&#46;98&#44; PO2 96&#44; PCO2 31&#44; and bicarbonate <br></br>4&#46;9 mEq&#47;l&#46; Plasma creatinine was 1&#47;53 mg&#47;dl&#44; BUN 33 mg&#47;dl&#44; sodium 135 mEq&#47;l&#44; potassium 6&#46;2 mEq&#47;l&#44; chloride 102 mEq&#47;l&#44; haemoglobin 16 g&#47;dl&#44; glucose 198 mg&#47;dl&#44; serum osmolarity 421 mOsm&#47;kg and lactic acid 10&#46;5 mmol&#47;l&#46; A head CT did not reveal any visible parenchymal or signs of cerebral haemorrhage&#46; <br></br><br></br>After questioning the family again&#44; the possibility that the patient had consumed approximately half a litre of methanol was mentioned&#46; <br></br><br></br>Treatment was initiated with pyridoxine&#44; thiamine&#44; nalaxone&#44; tiapride&#44; flumazenil&#44; sodium bicarbonate&#44; inotropics and intravenous ethanol&#46; Haemodialysis began approximately 3 hours after admission to ICU&#46; A highpermeability 2&#46;1 m2 surface area polysulfone membrane and a bicarbonate bath for 7 hours was used with blood flow at 300 ml&#47;min&#46; Unfortunately&#44; despite continuing inotropics and highdose bicarbonate&#44; the patient suffered from severe haemodynamic instability&#46; Due to the persistent deep coma without response to stimuli&#44; brain CT was repeated and demonstrated cerebral oedema and signs of transtentorial herniation that did not respond to treatment&#46; Faced with a situation of brain death&#44; authorisation for organ donation was requested and was given&#46; <br></br><br></br>Later&#44; the methanol levels from before haemodialysis &#40;1&#44;793 mg&#47;l&#41; and afterwards &#40;173&#46;4 mg&#47;dl&#41; were made <br></br>available&#46; <br></br><br></br>DISCUSSION <br></br><br></br>Acute methanol poisoning should be suspected in all patients with metabolic acidosis with an elevated anion gap&#44; neurological deterioration or vision loss&#46;2-4 Although methanol does not cause significant direct intoxication&#44; it is transformed by the liver to formaldehyde and formic acid with leads to metabolic acidosis and cases damage to all levels of the brain and the optic nerve&#46;2-4 Mortality from methanol poisoning is high&#46; In a recent study&#44; it has been established that it is much greater in patients with a blood pH below 7&#44; coma upon admission&#44; delay in seeking medical care and elevated plasma methanol levels&#46;5&#44;6 Treatment is based on inhibition of the alcohol dehydrogenase enzyme&#44; correction of metabolic acidosis and elimination of toxic metabolites by dialysis&#46; Enzyme <br></br>inhibition can be achieved with fomepizole or&#44; when this is not immediately available&#44; with ethanol&#46;7 Finally&#44; <br></br>haemodialysis with high-permeability membranes at a high flow rate for a prolonged period is capable of reducing <br></br>methanol levels as occurred in our patient&#46;8 <br></br><br></br>Unfortunately&#44; many cases lead to brain death and are potential multiorgan donors&#44; given that many publications <br></br>have demonstrated that the viability of the organs is adequate&#46;9 "
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Article information
ISSN: 20132514
Original language: English
DOI:
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