Adverse Drug Events Associated With the Antidotes for Methanol and Ethylene Glycol Poisoning: A Comparison of Ethanol and Fomepizole

Lepik, Katherine J; Levy, Adrian R.; Sobolev, Boris; Purssell, Roy; DeWitt, Chris; Erhardt, Gunnar D.; Kennedy, James R.; Daws, Derek E.; Brignall, Jane L.

doi:10.1016/j.annemergmed.2008.05.008

Cited by 71 publications

(34 citation statements)

References 28 publications

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“…6 Our study may have attributed some adverse events to ethanol that were due to other causes. However, the study by Lepik and colleagues examined a greater variety of adverse events compared to our study.…”

Section: Discussionmentioning

confidence: 89%

“…1,6 Although hypoglycemia is a commonly cited potential consequence of intravenous ethanol infusions, especially in children, we did not identify any instances, perhaps because ethanol is usually prepared in a dextrose solution for administration and perhaps because we excluded children. 4,6 Despite frequent ethanol serum concentration monitoring, ethanol concentrations were difficult to maintain in the target range. Only two patients had an ethanol serum concentration consistently within the target range throughout their entire course of therapy.…”

Section: Discussionmentioning

confidence: 97%

“…However, the study by Lepik and colleagues examined a greater variety of adverse events compared to our study. 6 Central nervous system toxicity characterized by agitation, decreased loss of consciousness, and seizures accounted for the most adverse events. Hypoglycemia was not identified, similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…Antidote selection could impact patient and health care worker safety, as well as the intensity of monitoring. 6 This study did not compare ethanol and fomepizole. It is likely that the risk benefit profile favours fomepizole based on the prevalence of adverse events alone.…”

Section: Discussionmentioning

confidence: 99%

“…One Canadian study reported a 57% incidence of adverse events with ethanol infusion. 6 Given these risks, intensive monitoring of the patient is required.…”

Section: Ré Sumémentioning

confidence: 99%

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The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

Wedge

Natarajan

Johanson

et al. 2012

CJEM

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Background: Methanol or ethylene glycol ingestion may result in significant morbidity or death without prompt treatment. Despite traditional and widespread use of intravenous ethanol as an antidote, its safety is not well described. An evaluation of the safety and ease of titrating ethanol infusions is necessary given the availability of an alternative antidote. Objective: To evaluate the safety and ease of titrating ethanol infusions for the treatment of methanol or ethylene glycol ingestion. Methods: We reviewed the hospital records of adults treated with ethanol at The Ottawa Hospital for methanol or ethylene glycol ingestion over a 9-year period. Using a standardized case report form, a single reviewer identified prespecified adverse events that developed after the start of ethanol therapy and classified dose adjustments during ethanol therapy as appropriate or inappropriate based on a priori criteria. Results: Forty-nine cases of methanol or ethylene glycol ingestion treated with ethanol were included in the analysis, of which 45 underwent hemodialysis, 38 were admitted to the intensive care unit, and 4 died. At least one adverse event was identified in 45 (92%) cases, including 35 (71%) with agitation requiring chemical or physical restraints and 10 (20%) with a depressed level of consciousness treated with intubation. The median number of ethanol concentration measurements per treatment course was 6 (range 0-24), of which only 27% were within the target range of 22 to 30 mmol/L and 47% were below. When measured concentrations were outside the target, the adjustment in ethanol dosing (or lack thereof) was deemed inappropriate 59% of the time, including 69% of the time during hemodialysis. Conclusion: Based on actual practice in a large academic centre, adverse events occur frequently with intravenous ethanol infusions, and ethanol titration is inefficient. The

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…One Canadian study reported a 57% incidence of adverse events with ethanol infusion. 6 Given these risks, intensive monitoring of the patient is required.…”

Section: Ré Sumémentioning

confidence: 99%

See 3 more Smart Citations

The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

Wedge

Natarajan

Johanson

et al. 2012

CJEM

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Severe visual loss caused by inhalational methanol poisoning in fireworks production: A report on 3 cases

Zhu

et al. 2021

American J Industrial Med

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Current awareness: Pharmacoepidemiology and drug safety

2009

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 23 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Antidiabetic Agents; 21 Contrast Agents; 22 Bone Conservation Agents; 23 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Adverse Drug Events Associated With the Antidotes for Methanol and Ethylene Glycol Poisoning: A Comparison of Ethanol and Fomepizole

Cited by 71 publications

References 28 publications

The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

Severe visual loss caused by inhalational methanol poisoning in fireworks production: A report on 3 cases

Current awareness: Pharmacoepidemiology and drug safety

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