Hossein Hassanian-Moghaddam1,2, Nasim Zamani1,2, Darren M Roberts3,4, Jeffrey Brent5, Kenneth McMartin6, Cynthia Aaron7,8, Michael Eddleston9, Paul I Dargan10, Kent Olson11, Lewis Nelson12, Ashish Bhalla13, Philippe Hantson14,15, Dag Jacobsen16, Bruno Megarbane17, Mahdi Balali-Mood18, Nicholas A Buckley19, Sergey Zakharov20, Raido Paasma21, Bhavesh Jarwani22, Amirhossein Mirafzal23, Tomas Salek24, Knut Erik Hovda25. 1. Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2. Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Department of Clinical Pharmacology and Toxicology, and Department of Renal Medicine, St Vincent's Hospital, University of NSW, Sydney, NSW, Australia. 4. NSW Poisons Information Centre, Sydney Children's Hospital, Westmead, Sydney, NSW, Australia. 5. School of Medicine, University of Colorado, Aurora, CO, USA. 6. Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA. 7. Michigan Regional Poison Control Center at Children's Hospital of Michigan, Detroit, MI, USA. 8. Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA. 9. Department of Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. 10. Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and Faculty of Life Sciences and Medicine, King's College London, London, UK. 11. California Poison Control System, San Francisco Division, University of California, San Francisco, San Francisco, CA, USA. 12. Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA. 13. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 14. Université catholique de Louvain, Cliniques universitaires Saint Luc, Bruxelles-Department of Intensive Care, Brussels, Belgium. 15. Université catholique de Louvain, Cliniques universitaires Saint Luc, Bruxelles-Louvain Centre for Toxicology and Applied Pharmacology, Brussels, Belgium. 16. Department of Acute Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway. 17. Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS 1144, Paris-Diderot University, Paris, France. 18. Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 19. Department of Pharmacology, University of Sydney, Sydney, Australia. 20. Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Toxicological Information Centre, Prague 2, Czech Republic. 21. Department of Anesthesiology and ICU, Pärnu County Hospital, Pärnu, Estonia. 22. Department of Emergency Medicine, VSGH, Ahmedabad, India. 23. Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. 24. Department of Clinical biochemistry and pharmacology, Tomas Bata Hospital, ZLÍN, Czech Republic. 25. The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
Abstract
Background: Methanol poisoning is an important cause of mortality and morbidity worldwide. Although it often occurs as smaller sporadic events, epidemic outbreaks are not uncommon due to the illicit manufacture and sale of alcoholic beverages.Objective: We aimed to define methanol poisoning outbreak (MPO), outline an approach to triaging an MPO, and define criteria for prioritizing antidotes, extracorporeal elimination treatments (i.e., dialysis), and indications for transferring patients in the context of an MPO. Methods: We convened a group of experts from across the world to explore geographical, socio-cultural and clinical considerations in the management of an MPO. The experts answered specific open-ended questions based on themes aligned to the goals of this project. This project used a modified Delphi process. The discussion continued until there was condensation of themes. Results: We defined MPO as a sudden increase in the number of cases of methanol poisoning during a short period of time above what is normally expected in the population in that specific geographic area. Prompt initiation of an antidote is necessary in MPOs. Scarce hemodialysis resources require triage to identify patients most likely to benefit from this treatment. The sickest patients should not be transferred unless the time for transfer is very short. Transporting extracorporeal treatment equipment and antidotes may be more efficient. Conclusion: We have developed consensus statements on the response to a methanol poisoning outbreak. These can be used in any country and will be most effective when they are discussed by health authorities and clinicians prior to an outbreak.
Background: Methanolpoisoning is an important cause of mortality and morbidity worldwide. Although it often occurs as smaller sporadic events, epidemic outbreaks are not uncommon due to the illicit manufacture and sale of alcoholic beverages.Objective: We aimed to define methanolpoisoning outbreak (MPO), outline an approach to triaging an MPO, and define criteria for prioritizing antidotes, extracorporeal elimination treatments (i.e., dialysis), and indications for transferring patients in the context of an MPO. Methods: We convened a group of experts from across the world to explore geographical, socio-cultural and clinical considerations in the management of an MPO. The experts answered specific open-ended questions based on themes aligned to the goals of this project. This project used a modified Delphi process. The discussion continued until there was condensation of themes. Results: We defined MPO as a sudden increase in the number of cases of methanolpoisoning during a short period of time above what is normally expected in the population in that specific geographic area. Prompt initiation of an antidote is necessary in MPOs. Scarce hemodialysis resources require triage to identify patients most likely to benefit from this treatment. The sickest patients should not be transferred unless the time for transfer is very short. Transporting extracorporeal treatment equipment and antidotes may be more efficient. Conclusion: We have developed consensus statements on the response to a methanolpoisoning outbreak. These can be used in any country and will be most effective when they are discussed by health authorities and clinicians prior to an outbreak.