![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
Abstract
Objectives. Methanol poisonings occur frequently globally, but reports of larger outbreaks where complete clinical and laboratory data are reported remain scarce. The objective of the present study was to report the data from the mass methanol poisoning in the Czech Republic in 2012 addressing the general epidemiology, treatment, and outcomes, and to present a protocol for the use of fomepizole ensuring that the antidote was provided to the most severely poisoned patients in the critical phase. Methods. A combined prospective and retrospective case series study of 121 patients with confirmed methanol poisoning. Results. From a total of 121 intoxicated subjects, 20 died outside the hospital and 101 were hospitalized. Among them, 60 survived without, and 20 with visual/CNS sequelae, whereas 21 patients died. The total and hospital mortality rates were 34% and 21%, respectively. Multivariate regression analysis found pH < 7.0 (OR 0.04 (0.01–0.16), p < 0.001), negative serum ethanol (OR 0.08 (0.02–0.37), p < 0.001), and coma on admission (OR 29.4 (10.2–84.6), p < 0.001) to be the only independent parameters predicting death. Continuous hemodialysis was used more often than intermittent hemodialysis, but there was no significant difference in mortality rate between the two [29% (n = 45) vs 17% (n = 30), p = 0.23]. Due to limited stockpiles of fomepizole, ethanol was administered more often; no difference in mortality rate was found between the two [16% (n = 70) vs. 24% (n = 21), p = 0.39]. The effect of folate administration both on the mortality rate and on the probability of visual sequelae was not significant (both p > 0.05). Conclusions. Severity of metabolic acidosis, state of consciousness, and serum ethanol on admission were the only significant parameters associated with mortality. The type of dialysis or antidote did not appear to affect mortality. Recommendations that were issued for hospital triage of fomepizole administration allowed conservation of valuable antidote in this massive poisoning outbreak for those patients most in need.
Acknowledgements
Supported with the Projects of the Charles University in Prague P25/1LF/2 and P28/1LF/6, the Project of the Ministry of Health of the Czech Republic 12/14/NAP, and EU Project “Material - technical Research Base for the Diagnostics and Treatment of Environmentally-caused and Oncological Disorders and their Risks, in the General University Hospital in Prague” (reg. No. CZ.2.16/3.1.00/24.12).
We would like to thank Prof. Michael Eddleston, MD, Ph.D., Edinburgh, Scotland, for the critical review of the manuscript.
We would like to thank the Heads of the Anesthesiology Departments and Intensive Care Units where the patients were treated, who provided us with the medical information and cooperated on this manuscript preparation: Cyril Kucera, Robert Bocek, Radovan Turek, Jiri Latta, Milan Kremer, Vitezslav Hrazdira, Tomas Mareth, Zdenek Belik, Jitka Matlochova, Marian Barta, Marie Kollarova, Viktor Talafa, Petr Bilina, Ludek Pluhacek, Zdenek Plhal, Pavel Klvana, Pavel Trestik, Miroslav Pojezny, Patrik Toya, Vlastimil Prochazka, Petr Hubacek, Jan Kristof, Martin Stritesky, and others, as well as the doctors, nurses and ambulance personnel who treated the poisoned patients and helped us to collect the necessary data.
Declaration of interest
The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.