Sandip Shah1, Vikas Pandey, Nilay Thakore, Ilesh Mehta. 1. Department of Medicine, Sheth K.M. School of Postgraduate Medicine and Research, Smt. N.H.L. Municipal Medical College, V.S. Hospital, Ahmedabad.
Abstract
BACKGROUND: Many outbreaks of methyl alcohol poisoning have been reported from India. Early and aggressive management with bicarbonate, ethanol and hemodialysis in patients having significant toxicity will decrease mortality and improve patient's outcome. Our experience of retro bulbar steroid injection indicates that it may improve visual outcome. MATERIALS AND METHODS: Hospital based study of patients admitted to V.S. Hospital during the outbreak of methanol poisoning in Ahmedabad. Patients were identified by history supplemented by ophthalmic examination and biochemistry. A stepwise treatment was undertaken i.e. aggressive treatment with bicarbonate, ethanol and institution of hemodialysis in patients who had refractory high anion gap metabolic acidosis, visual signs and symptoms, deteriorating vital signs and serum methanol level > 50 mg/dL. Patients who were having optic neuritis were given retrobulbar steroids. RESULTS: Total 63 males were admitted between 18 to 60 years. 17 patients were terminally ill with hypotension, could not be subjected for hemodialysis and expired. Of remaining 46 patients, 20 responded to conservative management whereas 26 underwent hemodialysis of which only 3 died. CONCLUSION: Patients undergoing hemodialysis showed immediate improvement in their clinical and biochemical parameters with rapid reductions of methyl alcohol levels below the toxic range with subsequent reduction in morbidity and mortality. All the patients given retrobulbar corticosteroid injection showed improvement in fundoscopic examination and perimetric charting with maximal improvement in visual acuity in hemodialysed patients.
BACKGROUND: Many outbreaks of methyl alcohol poisoning have been reported from India. Early and aggressive management with bicarbonate, ethanol and hemodialysis in patients having significant toxicity will decrease mortality and improve patient's outcome. Our experience of retro bulbar steroid injection indicates that it may improve visual outcome. MATERIALS AND METHODS: Hospital based study of patients admitted to V.S. Hospital during the outbreak of methanolpoisoning in Ahmedabad. Patients were identified by history supplemented by ophthalmic examination and biochemistry. A stepwise treatment was undertaken i.e. aggressive treatment with bicarbonate, ethanol and institution of hemodialysis in patients who had refractory high anion gap metabolic acidosis, visual signs and symptoms, deteriorating vital signs and serum methanol level > 50 mg/dL. Patients who were having optic neuritis were given retrobulbar steroids. RESULTS: Total 63 males were admitted between 18 to 60 years. 17 patients were terminally ill with hypotension, could not be subjected for hemodialysis and expired. Of remaining 46 patients, 20 responded to conservative management whereas 26 underwent hemodialysis of which only 3 died. CONCLUSION:Patients undergoing hemodialysis showed immediate improvement in their clinical and biochemical parameters with rapid reductions of methyl alcohol levels below the toxic range with subsequent reduction in morbidity and mortality. All the patients given retrobulbar corticosteroid injection showed improvement in fundoscopic examination and perimetric charting with maximal improvement in visual acuity in hemodialysed patients.
Authors: Philippe Lachance; Fabrice Mac-Way; Simon Desmeules; Sacha A De Serres; Anne-Sophie Julien; Pierre Douville; Marc Ghannoum; Mohsen Agharazii Journal: Kidney Int Date: 2015-08-05 Impact factor: 10.612