Methanol poisoning. Evolution of blood levels with high-flux haemodialysis
Intoxicación por metanol. Evolución de niveles sanguíneos con hemodiálisis de alto flujo
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Unidad de Hemodiálisis, Hospital Galdakao, Galdakao, Bizkaia, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 2 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Galdakao, Galdakao, Bizkaia, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicación por metanol. Evolución de niveles sanguíneos con hemodiálisis de alto flujo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10653_108_13128_en_10653_f31.jpg" "Alto" => 803 "Ancho" => 781 "Tamanyo" => 51962 ] ] "descripcion" => array:1 [ "en" => "Evolution of blood methanol levels during the haemodialysis sessions" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Although rare in our area, and related to accidents or suicide attempts, methanol poisoning is increasing due to the arrival of immigration.<span class="elsevierStyleSup">1</span> We report the case of a person with severe methanol poisoning treated with haemodialysis (HD). Serial samples were taken to assess the decrease of blood methanol levels during dialysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case report </span></p><p class="elsevierStylePara">A 38-year old male with a history of alcoholism was admitted to the emergency department with visual disturbances, abdominal pain and vomiting.</p><p class="elsevierStylePara">For days beforehand, he had been drinking perfume and 96° alcohol from a chemists. The day before admission, he voluntarily ingested 200ml of methylated spirit and ethanol (not knowing it was toxic.) He was admitted to the emergency room with blurred vision, unsteadiness, epigastric pain and an episode of vomiting which could not be distinguished as containing blood or not. He also reported fatigue and dyspnoea.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Physical examination in the emergency department </span></p><p class="elsevierStylePara">His breathing rate was 40 breaths per minute, with right hypochondrium pain. No bowel sounds were detected. His pupils were dilated, poorly reactive, and he was very sleepy. There was no language impairment, nystagmus or dysmetria in the finger-nose test.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Additional tests in the emergency department </span></p><p class="elsevierStylePara">Arterial blood gases: pH 6.99; pCO<span class="elsevierStyleInf">2</span> 8 mmHg; pO<span class="elsevierStyleInf">2</span> 138 mm Hg; bicarbonate 3mEq/l.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Biochemistry: glucose 132; urea 32, creatinine 1.15mg/dl; Na 133, K 5.5; Cl 101mEq/l; osmolality 371mOsm/kg.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Haemogram: WBC 23 400 (N 78, C 11, L 9, M 2); Hgb 18.3g/dl; Hct 56%; platelets 264 000.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Osmolar gap calculation: 92.3mOsm/kg (osmolality measurement - {Na [mEq/l] x 2 + urea/6 + glycaemia /18 (mg/dl)}).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Anion gap calculation: 34.5mEq/l ([Na + K] - [Cl + HCO<span class="elsevierStyleInf">3</span>]).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Methanol poisoning was suspected and 1M bicarbonate was prescribed and the patient was transferred to the ICU, where ethanol infusion is started. The patient was intubated for agitation and respiratory depression. The intravenous route was accessed and HD was begun with the following programme: two consecutive sessions of 4 hours, with a change of filter between, to prevent blood clots and loss of efficiency.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Monitor: Fresenius 4008S (Fresenius Medical Care).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Duration: 4 + 4 hours. Only stopped to change the filter and lines and purge the new system (10 min).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Membrane: polyarylethersulphone (Arylane M9, Gambro). Surface: 2.01m<span class="elsevierStyleSup">2</span>; UF coefficient 23ml/h/mm Hg, C. urea (Qb 300 and Qd 500, 264ml/min).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Qb (blood flow): 350ml/min, starting at 250ml/min, then after finding good haemodynamic tolerance at 1h, increased to 350ml/min.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Qd (dialysate flow): 800ml/min.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Dialysate: Fresenius A34 supplemented with KCl up to 4mEq/l.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">UF: zero.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Anticoagulation: enoxaparin (Clexane) 20 at the start of each session.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Dose of ethanol doubled during the dialysis.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">After dialysis the patient improved clinically, and was extubated and transferred to the psychiatric ward the same day.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Hourly methanol extractions were performed (at the start of HD, and then hourly) and 4 hours after ending the second session (Figure 1). The levels were significantly reduced, reaching minimum values after the third hour. However, when stopping dialysis (while changing the filter) a relapse (64mg/dl) was noted, but the patient returned to minimum values after restarting the session.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara">HD<span class="elsevierStyleSup">2-4</span> is used for severe methanol poisoning. Its indications are<span class="elsevierStyleSup">5</span>: blood methanol level >50 mg/dl (not immediately available in our centre), severe metabolic acidosis, visual or neurological disturbances and >30ml methanol intake.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Very prolonged HD sessions have been reported (>1 day).<span class="elsevierStyleSup">6</span> Hirsch<span class="elsevierStyleSup">7</span> calculates the duration of HD according to levels of methanol [t(hours)=-Vln(5/A)/0.06k, where t is time in hours, V is the volume of body water measured by Watson, A is the level of methanol in blood in mg/dl and k is 80% of urea clearance estimated by the manufacturer]. The level of methanol can be inferred using the osmolar gap, since there is a good correlation between both values,<span class="elsevierStyleSup">1</span> minus the normal gap (10-12mOsm/kg). In our case the gap was 92mOsm/kg, which would be about 250mg/dl, with an estimated HD duration of 9 hours.</p><p class="elsevierStylePara">The fall of methanol in the blood was greater than in the Hirsch study,<span class="elsevierStyleSup">7</span> with a relapse while the filter was being changed. This may be because large surface membranes with a high dialysate flow the poison is quickly removed from the vascular compartment, but time is needed for the rest of the poison to be released from the extra-vascular space into the bloodstream.</p><p class="elsevierStylePara">There are no studies comparing intermittent and continuous HD techniques,<span class="elsevierStyleSup">1,8</span> but obviously intermittent HD is always faster. If these findings are confirmed, combining the two techniques should be considered (for example, HD of 3-4 hours followed by the continuous technique) or the Hirsch formula corrected.</p><p class="elsevierStylePara"><a href="grande/10653_108_13128_en_10653_f31.jpg" class="elsevierStyleCrossRefs"><img src="10653_108_13128_en_10653_f31.jpg" alt="Evolution of blood methanol levels during the haemodialysis sessions"></img></a></p><p class="elsevierStylePara">Figure 1. 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Tratamiento de las intoxicaciones graves por alcoholes. Nefrologia 2008;28:369-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18662143" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Holubek WJ, Hoffman RS, Goldferb DS, Nelson LS. Use of hemodiaysis and hemoperfusion in poisoned patients. Kidney Int 2008;74:1327-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18800032" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Peces R, Fernández R, Peces C, González E, Olivas E, Renjel F, et al. Eficacia de la hemodiálisis precoz con membranas de alto flujo en el tratamiento de las intoxicaciones graves por alcoholes. Nefrologia 2008;28:413-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18662149" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Arriba G, Torres-Guinea M, Chevarría J, Basterrechea MA. Utilidad de la hemodiálisis prolongada en el tratamiento de la intoxicación aguda por metanol. Nefrologia 2008;28:664-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19016652" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Krant JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis and management. Clin J Am Soc Nephrol 2008;3:208-25. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18045860" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Seyffort G. Poison Index. The treatment of acute intoxication (4.ª\u{A0}ed.). Lergerich: Pabst Science Publishers; 1997. p. 457-64." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hirsch DJ, Jindel KK, Wong P, Fraser AD. A simple method to estimate the required dialysis time for cases of alcohol poisoning. Kidney Int 2001;60:2021-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11703622" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tyagi PK, Winchester JF, Feinfeld DA. Extracorporeal removal of toxins. Kidney Int 2008;74:1231-3.[Pubmed <a href="http://www.ncbi.nlm.nih.gov/pubmed/18974758" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000001/v0_201502091643/X2013251411051089/v0_201502091644/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000001/v0_201502091643/X2013251411051089/v0_201502091644/en/P1-E515-S2802-A10653-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051089?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 5 | 12 |
| 2024 October | 83 | 32 | 115 |
| 2024 September | 83 | 27 | 110 |
| 2024 August | 91 | 54 | 145 |
| 2024 July | 99 | 35 | 134 |
| 2024 June | 114 | 43 | 157 |
| 2024 May | 109 | 41 | 150 |
| 2024 April | 75 | 37 | 112 |
| 2024 March | 88 | 28 | 116 |
| 2024 February | 64 | 35 | 99 |
| 2024 January | 75 | 23 | 98 |
| 2023 December | 61 | 32 | 93 |
| 2023 November | 82 | 38 | 120 |
| 2023 October | 97 | 52 | 149 |
| 2023 September | 82 | 35 | 117 |
| 2023 August | 92 | 22 | 114 |
| 2023 July | 149 | 32 | 181 |
| 2023 June | 102 | 33 | 135 |
| 2023 May | 113 | 46 | 159 |
| 2023 April | 91 | 46 | 137 |
| 2023 March | 97 | 26 | 123 |
| 2023 February | 92 | 42 | 134 |
| 2023 January | 78 | 27 | 105 |
| 2022 December | 128 | 40 | 168 |
| 2022 November | 109 | 43 | 152 |
| 2022 October | 104 | 46 | 150 |
| 2022 September | 109 | 39 | 148 |
| 2022 August | 115 | 65 | 180 |
| 2022 July | 92 | 64 | 156 |
| 2022 June | 76 | 40 | 116 |
| 2022 May | 97 | 45 | 142 |
| 2022 April | 110 | 61 | 171 |
| 2022 March | 103 | 48 | 151 |
| 2022 February | 156 | 62 | 218 |
| 2022 January | 151 | 32 | 183 |
| 2021 December | 107 | 46 | 153 |
| 2021 November | 103 | 41 | 144 |
| 2021 October | 102 | 53 | 155 |
| 2021 September | 93 | 39 | 132 |
| 2021 August | 104 | 30 | 134 |
| 2021 July | 94 | 42 | 136 |
| 2021 June | 70 | 22 | 92 |
| 2021 May | 109 | 33 | 142 |
| 2021 April | 310 | 79 | 389 |
| 2021 March | 155 | 37 | 192 |
| 2021 February | 126 | 44 | 170 |
| 2021 January | 62 | 20 | 82 |
| 2020 December | 58 | 16 | 74 |
| 2020 November | 58 | 30 | 88 |
| 2020 October | 52 | 16 | 68 |
| 2020 September | 43 | 10 | 53 |
| 2020 August | 61 | 17 | 78 |
| 2020 July | 67 | 17 | 84 |
| 2020 June | 55 | 19 | 74 |
| 2020 May | 72 | 15 | 87 |
| 2020 April | 68 | 9 | 77 |
| 2020 March | 79 | 13 | 92 |
| 2020 February | 40 | 21 | 61 |
| 2020 January | 70 | 23 | 93 |
| 2019 December | 49 | 24 | 73 |
| 2019 November | 64 | 12 | 76 |
| 2019 October | 30 | 12 | 42 |
| 2019 September | 56 | 23 | 79 |
| 2019 August | 38 | 8 | 46 |
| 2019 July | 58 | 28 | 86 |
| 2019 June | 58 | 8 | 66 |
| 2019 May | 54 | 17 | 71 |
| 2019 April | 100 | 25 | 125 |
| 2019 March | 44 | 19 | 63 |
| 2019 February | 22 | 17 | 39 |
| 2019 January | 32 | 15 | 47 |
| 2018 December | 142 | 33 | 175 |
| 2018 November | 142 | 15 | 157 |
| 2018 October | 121 | 14 | 135 |
| 2018 September | 77 | 10 | 87 |
| 2018 August | 48 | 19 | 67 |
| 2018 July | 55 | 10 | 65 |
| 2018 June | 50 | 19 | 69 |
| 2018 May | 59 | 12 | 71 |
| 2018 April | 65 | 3 | 68 |
| 2018 March | 37 | 12 | 49 |
| 2018 February | 49 | 2 | 51 |
| 2018 January | 35 | 9 | 44 |
| 2017 December | 34 | 8 | 42 |
| 2017 November | 31 | 1 | 32 |
| 2017 October | 43 | 10 | 53 |
| 2017 September | 44 | 11 | 55 |
| 2017 August | 34 | 6 | 40 |
| 2017 July | 40 | 10 | 50 |
| 2017 June | 30 | 2 | 32 |
| 2017 May | 47 | 11 | 58 |
| 2017 April | 32 | 18 | 50 |
| 2017 March | 34 | 9 | 43 |
| 2017 February | 31 | 8 | 39 |
| 2017 January | 20 | 12 | 32 |
| 2016 December | 39 | 5 | 44 |
| 2016 November | 57 | 14 | 71 |
| 2016 October | 83 | 13 | 96 |
| 2016 September | 100 | 8 | 108 |
| 2016 August | 157 | 8 | 165 |
| 2016 July | 172 | 16 | 188 |
| 2016 June | 142 | 0 | 142 |
| 2016 May | 158 | 0 | 158 |
| 2016 April | 100 | 0 | 100 |
| 2016 March | 89 | 0 | 89 |
| 2016 February | 98 | 0 | 98 |
| 2016 January | 96 | 0 | 96 |
| 2015 December | 136 | 0 | 136 |
| 2015 November | 109 | 0 | 109 |
| 2015 October | 107 | 0 | 107 |
| 2015 September | 67 | 0 | 67 |
| 2015 August | 80 | 0 | 80 |
| 2015 July | 62 | 0 | 62 |
| 2015 June | 30 | 0 | 30 |
| 2015 May | 52 | 0 | 52 |
| 2015 April | 6 | 0 | 6 |
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