A Systematic Review of Ethanol and Fomepizole Use in Toxic Alcohol Ingestions

Beatty, Lorri; Green, Robert C.; Magee, Kirk; Zed, Peter J.

doi:10.1155/2013/638057

Cited by 45 publications

(35 citation statements)

References 133 publications

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“…This allowed for management of the most severely poisoned patients through the most critical phases, including the dialysis sessions where ethanol dosing is especially difficult 37 . The relatively higher prevalence of visual and CNS sequelae in our study compared to the literature, where 18-30% have been reported 26,36 , can be explained as an underestimation of the long-term impairment due to the absence of follow-up prospective studies in patients who survived poisonings with complete ocular and neurological examinations, and CT/MRI of brain to detect the subclinical damage to the basal ganglia.…”

Section: Discussioncontrasting

confidence: 80%

“…Fomepizole administration as a first-choice antidote is a well-established treatment in patients with acute methanol poisoning 14,34 . However, the relative efficacy of fomepizole is still under discussion 35,36 . In our study, fomepizole was administered to patients hospitalized during the outbreak of mass methanol poisonings in the Czech Republic.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians should consider other factors, including cost, efficiency, resource utilization, patient demographic, availability of antidote, and familiarity with the drug when making decisions on the management of toxic alcohol ingestion 36 ".…”

Section: Discussionmentioning

confidence: 99%

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Fomepizole in the treatment of acute methanol poisonings: Experience from the Czech mass methanol outbreak 2012-2013

Zakharov¹,

Navrátil²,

Pelclová³

2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Objective. During an outbreak of mass methanol poisonings in the Czech Republic in 2012-2013, fomepizole was applied as an alternative antidote to ethanol. We present the laboratory data, clinical features, adverse reactions, and treatment outcomes in all patients treated with fomepizole. Methods. Combined retrospective and prospective case series study in 25 patients, median age 50 (16-73) years, 18 males and 7 females. Results. There were 24% fatalities, 36% survivors without health impairment, and 40% survivors with sequelae. All the patients who died were comatose on admission; the mortality was 50% among patients in a coma. The median intensive care unit length of stay was six (2-22) days. The median total dose of fomepizole was 2 (1-9) g. Complications were observed in 7/25 cases: aspiration pneumonia (4), sepsis (2), bleeding (2), malignant arrhythmia (1), delirium tremens (1), and rebound of acidosis (1). The patients who survived without impairment were less acidotic than those who died or survived with sequelae (P<0.01). No difference in serum methanol and formate was found between the three groups. Conclusion. There is no evidence whether fomepizole is a more efficient antidote than ethanol with regards to the hospital mortality. The possibility of delirium tremens in the patients with a history of chronic alcohol abuse has to be taken in consideration. The benefits of fomepizole were indirect: no need to monitor serum ethanol's level during the hemodialysis in severely poisoned patients and less working overload on ICU doctors treating several poisoned patients simultaneously.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Fomepizole in the treatment of acute methanol poisonings: Experience from the Czech mass methanol outbreak 2012-2013

Zakharov¹,

Navrátil²,

Pelclová³

2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Although both ethanol and fomepizole are effective, fomepizole is the preferred antidote for methanol poisoning 2. According to a systematic review,3 the mortality in patients treated with ethanol was 21.8% and in those administered fomepizole, was 17.1%. The mortality in patients treated with both antidotes was 5.5% 3.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for mortality in Asian Taiwanese patients with methanol poisoning

Lee¹,

Chang²,

Lin³

et al. 2014

TCRM

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IntroductionMethanol poisoning continues to be a serious public health issue in Taiwan, but very little work has been done to study the outcomes of methanol toxicity in the Asian population. In this study, we examined the value of multiple clinical variables in predicting mortality after methanol exposure.MethodsWe performed a retrospective observational study on patients with acute poisoning who were admitted to the Chang Gung Memorial Hospital over a period of 9 years (2000–2008). Out of the 6,347 patients, only 32 suffered methanol intoxication. The demographic, clinical, laboratory, and mortality data were obtained for analysis.ResultsMost patients were middle aged (46.1±13.8 years), male (87.5%), and habitual alcohol consumers (75.0%). All the poisonings were from an oral exposure (96.9%), except for one case of intentionally injected methanol (3.1%). After a latent period of 9.3±10.1 hours, many patients began to experience hypothermia (50.0%), hypotension (15.6%), renal failure (59.4%), respiratory failure (50.0%), and consciousness disturbance (Glasgow coma scale [GCS] score 10.5±5.4). Notably, the majority of patients were treated with ethanol antidote (59.4%) and hemodialysis (58.1%). The remaining 41.6% of patients did not meet the indications for ethanol therapy. At the end of analysis, there were six (18.8%), 15 (46.9%), and eleven (34.4%) patients alive, alive with chronic complications, and dead, respectively. In a multivariate Cox regression model, it was revealed that the GCS score (odds ratio [OR] 0.816, 95% confidence interval [CI] 0.682–0.976) (P=0.026), hypothermia (OR 168.686, 95% CI 2.685–10,595.977) (P=0.015), and serum creatinine level (OR 4.799, 95% CI 1.321–17.440) (P=0.017) were significant risk factors associated with mortality.ConclusionThe outcomes (mortality rate 34.4%) of the Taiwanese patients subjected to intensive detoxification protocols were comparable with published data from other international poison centers. Furthermore, the analytical results indicate that GCS score, hypothermia, and serum creatinine level help predict mortality after methanol poisoning.

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“…37 En la inhibición de la alcohol deshidrogenasa es de elección el fomepizol sobre el etanol, debido a que el primero no induce embriaguez, hipoglucemia o irritación gástrica, que representan problemas frecuentes con el empleo de etanol (la irritación gástrica se presenta con la administración enteral de etanol). 40,41 El fomepizol se indica con una dosis inicial de 15 mg/kg, seguido de dosis de mantenimiento de 10 mg/ kg cada 12 horas, reajustándolas a cada 4 horas en caso de que se requiera hemodiálisis. Una alternativa eficaz es el etanol por vía enteral o intravenosa, con una dosis inicial de 800 mg/kg de peso para administrar en 20 minutos, seguida de dosis de mantenimiento de 80 a 150 mg/kg por hora, manteniendo al paciente en un estado leve de embriaguez (100 a 150 mg/dL en suero); [37][38][39] en este caso, si se inicia terapia con hemodiáli-sis el aporte también deberá ajustarse de 250 a 350 mg/kg por hora.…”

Section: Alcoholesunclassified

CHAMACON: exposiciones potencialmente letales en pediatría

Bazán-Godínez

Pérez-Tuñon

2016

Acta Pediatr Mex

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Accidental exposure to potentially toxic substances is a common problem in children. This condition could be catastrophic, depending on factors associated with the patient, their environment and the substance involved. In this sense, there is a group of commonly used substances that when ingested by an infant, even in small amounts (one tablet, sip or spoonful), may cause death, either because they are highly toxic or simply because they are in a high concentration. When a child ingests any of these substances, it should be recognized as "a potentially lethal exposure". We propose the mnemonics CHAMA-CON to identify those substances and subsequently, we mentioned key aspects for the initial treatment in this exposures. KEYWORDS: poisoning in children; lethal exposures in pediatricsActa Pediatr Mex. 2016 jul;37(4):228-240. CHAMACON: exposiciones potencialmente letales en pediatría ResumenLa exposición accidental a sustancias potencialmente tóxicas es un problema frecuente en pediatría. Esta condición puede ser catastrófica dependiendo de factores propios del paciente, su entorno y de la propia sustancia a la que fue expuesto. En este sentido, existe un grupo de sustancias de uso común que al ser ingeridas por un lactante, aun en cantidades mínimas (una tableta, un sorbo o una cucharada), pueden causarle la muerte, ya sea porque son altamente tóxicas o simplemente porque se encuentran en una gran concentración. Cuando un niño ingiere cualquier sustancia de este grupo debe reconocerse como una "exposición potencialmente letal en pediatría". En el presente trabajo se propone la nemotecnia CHAMACON para lograr un sencillo reconocimiento de dichas sustancias y posteriormente se abordan aspectos clave en el abordaje inicial del paciente que ha presentado una exposición de esta índole.PALABRAS CLAVE: intoxicaciones en niños, exposiciones letales en pediatría.

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A Systematic Review of Ethanol and Fomepizole Use in Toxic Alcohol Ingestions

Cited by 45 publications

References 133 publications

Fomepizole in the treatment of acute methanol poisonings: Experience from the Czech mass methanol outbreak 2012-2013

Fomepizole in the treatment of acute methanol poisonings: Experience from the Czech mass methanol outbreak 2012-2013

Risk factors for mortality in Asian Taiwanese patients with methanol poisoning

CHAMACON: exposiciones potencialmente letales en pediatría

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