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        "resumen" => "La intoxicaci&#243;n por alcoholes &#40;metanol&#44; etanol y etilenglicol&#41; origina acidosis metab&#243;lica severa con hiato ani&#243;nico y osmolal elevados&#44; alteraciones neurol&#243;gicas que van desde la obnubilaci&#243;n al coma profundo&#44; amaurosis&#44; y muerte&#46; A pesar de la terapia intensiva la morbilidad y la mortalidad siguen siendo muy elevadas&#46; En la intoxicaci&#243;n por etilenglicol&#44; adem&#225;s&#44; puede ocurrir la precipitaci&#243;n masiva de oxalato en los tejidos&#44; sobre todo en el ri&#241;&#243;n&#44; produciendo un fracaso renal agudo&#46; El tratamiento establecido&#44; en las intoxicaciones por metanol y etilenglicol&#44; es la administraci&#243;n de etanol y la hemodi&#225;lisis &#40;HD&#41; precoz&#46; La HD convencional puede reducir r&#225;pidamente los niveles de metanol&#44; etanol y etilenglicol&#44; as&#237; como los de sus metabolitos t&#243;xicos&#44; corrigiendo tambi&#233;n los trastornos electrol&#237;ticos y &#225;cido-base&#46; Las membranas de alto flujo son capaces de eliminar m&#225;s cantidad de t&#243;xico por hora de HD pudiendo ser m&#225;s eficaces en el tratamiento&#46; En este estudio se presentan 14 casos de intoxicaci&#243;n por alcoholes &#40;11 metanol&#44; 1 etanol y 2 etilenglicol&#41; tratados precozmente con bicarbonato&#44; infusi&#243;n de etanol &#40;para metanol y etilenglicol&#41; y HD con membranas de alto flujo&#46; Al ingreso el pH medio fue 7&#44;04 &#177; 0&#44;06 &#40;rango 6&#44;60-7&#44;33&#41;&#44; el bicarbonato medio de 9&#44;9 &#177; 1&#44;9 mmol&#47;l &#40;rango 1&#44;4-25&#41; y el d&#233;ficit de bases medio de 18&#44;4 &#177; 2&#44;6 mmol&#47;l &#40;rango 2-33&#41;&#46; El hiato ani&#243;nico inicial fue de 29&#44;1 &#177; 2&#44;3 mmol&#47;l &#40;rango 16-45&#41; y el hiato osmolal de 119 &#177; 47 mOsm&#47;l &#40;rango 16-402&#41;&#46; Existi&#243; una excelente correlaci&#243;n lineal entre los niveles s&#233;ricos iniciales del alcohol t&#243;xico y el hiato osmolal &#40;R2 &#61; 0&#44;98&#44; p &#61; 0&#44;0006&#41;&#46; En todos los casos&#44; el tratamiento precoz con HD corrigi&#243; la acidosis metab&#243;lica y el hiato osmolal&#46; De los 14 casos&#44; 11 sobrevivieron sin secuelas&#44; 2 quedaron con amaurosis y 1 falleci&#243; &#40;mortalidad 7 &#37;&#41;&#46; Se concluye que en las intoxicaciones severas por alcoholes la HD debe instaurarse precozmente&#46; La infusi&#243;n de etanol&#44; al frenar el metabolismo del metanol y del etilenglicol&#44; permite la eliminaci&#243;n r&#225;pida por HD de los alcoholes y sus metabolitos t&#243;xicos&#46; La prescripci&#243;n de HD debe incluir un dializador de alto flujo y gran superficie&#44; un flujo sangu&#237;neo elevado&#44; un ba&#241;o de bicarbonato con concentraciones normales de potasio y f&#243;sforo&#44; y debe prolongarse el tiempo necesario&#46; La modificaci&#243;n del ba&#241;o de HD evita la hipofosfatemia y la hipopotasemia&#46; La HD seg&#250;n fue implementada en estos casos es una forma segura y efectiva de tratamiento de la intoxicaci&#243;n grave por alcoholes&#46; "
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        "resumen" => "Alcohol intoxication &#40;methanol&#44; ethanol and ethylene glycol&#41; may result in metabolic acidosis with increased anion gap&#44; increased serum osmolal gap&#44; and neurologic abnormalities ranging from drunkenness to coma&#44; and death&#46; The mortality and morbidity rates remain very high despite intensive care therapy&#46; The toxicity of methanol and ethylene glycol is clearly correlated to the degree of metabolic acidosis&#46; The established treatment of severe methanol and ethylene glycol intoxication is ethanol administration and hemodialysis &#40;HD&#41;&#46; By inhibiting the main metabolic pathway of methanol and ethylene glycol &#40;alcohol dehydrogenase&#41;&#44; ethanol prevents the formation of major toxic metabolites &#40;formic acid&#44; glycolic acid and oxalic acid&#41;&#46; Conventional HD can reduce serum methanol&#44; ethanol and ethylene glycol and its metabolites rapidly&#44; but high-flux membranes should be capable of removing more toxic per hour of HD&#46; In this report&#44; we describe 14 cases of life-threatening alcohol intoxication &#40;11 methanol&#44; 1 ethanol&#44; and 2 ethylene glycol&#41; who were treated successfully with supportive care&#44; ethanol infusion &#40;methanol and ethylene glycol&#41;&#44; and early HD with a high-flux dialyser&#46; The median pH was 7&#46;04 &#177; 0&#46;06 &#40;range 6&#46;60-7&#46;33&#41;&#44; median bicarbonate 9&#46;9 &#177; 1&#46;9 mmol&#47;l &#40;range 1&#46;4-25&#41;&#44; and median base deficit 18&#46;4 &#177; 2&#46;6 mmol&#47;l &#40;range 2-33&#41;&#46; The median anion gap was 29&#46;1 &#177; 2&#46;3 mmol&#47;l &#40;range 16-45&#41; and the median osmolal gap was 119 &#177; 47 mOsm&#47;l &#40;range 16-402&#41;&#46; On admission there was an excellent linear correlation between the serum toxic alcohol concentrations and the osmolal gaps &#40;R2 &#61; 0&#46;98&#44; p &#61; 0&#46;0006&#41;&#46; In all cases early HD corrected metabolic acidosis and osmolal abnormalities&#46; The mortality was 7&#37; &#40;1 from 14&#41;&#46; We conclude that pre-emptive HD should be performed in severe intoxications to remove both the parent compound and its metabolites&#46; The HD prescription should include a large surface area dialyser with high-flux membrane&#44; a blood flow rate in excess of 250 ml&#47;min&#44; a modified bicarbonate bath enriched with phosphorus and potassium&#44; and a long time session&#46; The phosphorus and potassium- enriched bicarbonate-based dialysis solution used in patients with normal phosphorus and potassium serum levels avoided HD-induced hypophosphatemia and hypopotassemia&#46; HD as implemented in these cases is a safe and very effective approach to the management of alcohol poisoning&#46;"
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Effectiveness of pre-emptive hemodialysis with high-flux membranes for the treatment of lifethreatening alcohol poisoning
Eficacia de la hemodiálisis precoz con membranas de alto flujo en el tratamiento de las intoxicaciones graves por alcoholes
Ramón Pecesa, Elena Gonzáleza, Elena Olivasa, Fernando Renjela, Olga Costeroa, Agustín Monteroa, Rafael Selgasa, Raquel Fernándezb, Manuel Jiménezb, Carlos Pecesc
a Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Madrid, España,
b Unidad de Cuidados Intensivos, Hospital Universitario La Paz, Madrid, Madrid, España,
c Área de Tecnología de la Información, SESCAM, Toledo, Toledo, España,
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        "resumen" => "La intoxicaci&#243;n por alcoholes &#40;metanol&#44; etanol y etilenglicol&#41; origina acidosis metab&#243;lica severa con hiato ani&#243;nico y osmolal elevados&#44; alteraciones neurol&#243;gicas que van desde la obnubilaci&#243;n al coma profundo&#44; amaurosis&#44; y muerte&#46; A pesar de la terapia intensiva la morbilidad y la mortalidad siguen siendo muy elevadas&#46; En la intoxicaci&#243;n por etilenglicol&#44; adem&#225;s&#44; puede ocurrir la precipitaci&#243;n masiva de oxalato en los tejidos&#44; sobre todo en el ri&#241;&#243;n&#44; produciendo un fracaso renal agudo&#46; El tratamiento establecido&#44; en las intoxicaciones por metanol y etilenglicol&#44; es la administraci&#243;n de etanol y la hemodi&#225;lisis &#40;HD&#41; precoz&#46; La HD convencional puede reducir r&#225;pidamente los niveles de metanol&#44; etanol y etilenglicol&#44; as&#237; como los de sus metabolitos t&#243;xicos&#44; corrigiendo tambi&#233;n los trastornos electrol&#237;ticos y &#225;cido-base&#46; Las membranas de alto flujo son capaces de eliminar m&#225;s cantidad de t&#243;xico por hora de HD pudiendo ser m&#225;s eficaces en el tratamiento&#46; En este estudio se presentan 14 casos de intoxicaci&#243;n por alcoholes &#40;11 metanol&#44; 1 etanol y 2 etilenglicol&#41; tratados precozmente con bicarbonato&#44; infusi&#243;n de etanol &#40;para metanol y etilenglicol&#41; y HD con membranas de alto flujo&#46; Al ingreso el pH medio fue 7&#44;04 &#177; 0&#44;06 &#40;rango 6&#44;60-7&#44;33&#41;&#44; el bicarbonato medio de 9&#44;9 &#177; 1&#44;9 mmol&#47;l &#40;rango 1&#44;4-25&#41; y el d&#233;ficit de bases medio de 18&#44;4 &#177; 2&#44;6 mmol&#47;l &#40;rango 2-33&#41;&#46; El hiato ani&#243;nico inicial fue de 29&#44;1 &#177; 2&#44;3 mmol&#47;l &#40;rango 16-45&#41; y el hiato osmolal de 119 &#177; 47 mOsm&#47;l &#40;rango 16-402&#41;&#46; Existi&#243; una excelente correlaci&#243;n lineal entre los niveles s&#233;ricos iniciales del alcohol t&#243;xico y el hiato osmolal &#40;R2 &#61; 0&#44;98&#44; p &#61; 0&#44;0006&#41;&#46; En todos los casos&#44; el tratamiento precoz con HD corrigi&#243; la acidosis metab&#243;lica y el hiato osmolal&#46; De los 14 casos&#44; 11 sobrevivieron sin secuelas&#44; 2 quedaron con amaurosis y 1 falleci&#243; &#40;mortalidad 7 &#37;&#41;&#46; Se concluye que en las intoxicaciones severas por alcoholes la HD debe instaurarse precozmente&#46; La infusi&#243;n de etanol&#44; al frenar el metabolismo del metanol y del etilenglicol&#44; permite la eliminaci&#243;n r&#225;pida por HD de los alcoholes y sus metabolitos t&#243;xicos&#46; La prescripci&#243;n de HD debe incluir un dializador de alto flujo y gran superficie&#44; un flujo sangu&#237;neo elevado&#44; un ba&#241;o de bicarbonato con concentraciones normales de potasio y f&#243;sforo&#44; y debe prolongarse el tiempo necesario&#46; La modificaci&#243;n del ba&#241;o de HD evita la hipofosfatemia y la hipopotasemia&#46; La HD seg&#250;n fue implementada en estos casos es una forma segura y efectiva de tratamiento de la intoxicaci&#243;n grave por alcoholes&#46; "
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        "resumen" => "Alcohol intoxication &#40;methanol&#44; ethanol and ethylene glycol&#41; may result in metabolic acidosis with increased anion gap&#44; increased serum osmolal gap&#44; and neurologic abnormalities ranging from drunkenness to coma&#44; and death&#46; The mortality and morbidity rates remain very high despite intensive care therapy&#46; The toxicity of methanol and ethylene glycol is clearly correlated to the degree of metabolic acidosis&#46; The established treatment of severe methanol and ethylene glycol intoxication is ethanol administration and hemodialysis &#40;HD&#41;&#46; By inhibiting the main metabolic pathway of methanol and ethylene glycol &#40;alcohol dehydrogenase&#41;&#44; ethanol prevents the formation of major toxic metabolites &#40;formic acid&#44; glycolic acid and oxalic acid&#41;&#46; Conventional HD can reduce serum methanol&#44; ethanol and ethylene glycol and its metabolites rapidly&#44; but high-flux membranes should be capable of removing more toxic per hour of HD&#46; In this report&#44; we describe 14 cases of life-threatening alcohol intoxication &#40;11 methanol&#44; 1 ethanol&#44; and 2 ethylene glycol&#41; who were treated successfully with supportive care&#44; ethanol infusion &#40;methanol and ethylene glycol&#41;&#44; and early HD with a high-flux dialyser&#46; The median pH was 7&#46;04 &#177; 0&#46;06 &#40;range 6&#46;60-7&#46;33&#41;&#44; median bicarbonate 9&#46;9 &#177; 1&#46;9 mmol&#47;l &#40;range 1&#46;4-25&#41;&#44; and median base deficit 18&#46;4 &#177; 2&#46;6 mmol&#47;l &#40;range 2-33&#41;&#46; The median anion gap was 29&#46;1 &#177; 2&#46;3 mmol&#47;l &#40;range 16-45&#41; and the median osmolal gap was 119 &#177; 47 mOsm&#47;l &#40;range 16-402&#41;&#46; On admission there was an excellent linear correlation between the serum toxic alcohol concentrations and the osmolal gaps &#40;R2 &#61; 0&#46;98&#44; p &#61; 0&#46;0006&#41;&#46; In all cases early HD corrected metabolic acidosis and osmolal abnormalities&#46; The mortality was 7&#37; &#40;1 from 14&#41;&#46; We conclude that pre-emptive HD should be performed in severe intoxications to remove both the parent compound and its metabolites&#46; The HD prescription should include a large surface area dialyser with high-flux membrane&#44; a blood flow rate in excess of 250 ml&#47;min&#44; a modified bicarbonate bath enriched with phosphorus and potassium&#44; and a long time session&#46; The phosphorus and potassium- enriched bicarbonate-based dialysis solution used in patients with normal phosphorus and potassium serum levels avoided HD-induced hypophosphatemia and hypopotassemia&#46; HD as implemented in these cases is a safe and very effective approach to the management of alcohol poisoning&#46;"
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Original language: English
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?