An Outbreak of Acute Methyl Alcohol Intoxication

Abstract

An outbreak of acute methyl alcohol intoxication occurred in Port Moresby, Papua New Guinea, in March 1977. Twenty-eight young men attended a drinking party and drank methyl alcohol. The amount consumed by each individual ranged from an equivalent of 60--600 ml of pure methanol. Three had prior ethanol ingestion. All 28 became ill 8--36 hours after drinking and were hospitalized. The most commonly observed clinical syndromes were: acute metabolic acidosis, severe visual impairment and acute pancreatitis. Four died within 72 hours after admission to the hospital. All had severe metabolic acidosis and visual impairment and three pancreatitis. Of 24 who recovered, 16 showed no residual complications, six had bi-lateral visual impairment and two had difficulty in speech as well as visual impairment. A three month follow-up examination showed no change in the findings. Coma, seizures and prolonged acidosis were poor prognostic signs. The estimated amount of consumed methanol and the rapidity of the appearance of signs of toxicity following methanol ingestion did not seem to influence the outcome of poisoning. The treatment of acute methyl alcohol intoxication in centres where dialysis is not available is discussed.

Can Fomepizole be Substituted by Abacavir in the Treatment of Methanol Poisoning?

“…To test this hypothesis, the affinity of abacavir for ADH in comparison with methanol should firstly be experimentally determined and if it is shown that it has a greater affinity for ADH compared with methanol, a multicenter randomized controlled trial study should be designed to compare fomepizole with abacavir in the treatment of methanol-poisoned patients. Albeit, the best opportunities for conducting this study are the mass poisonings with methanol that regularly occur in developed and developing countries [9,[18][19][20][21].…”

“…In contrary, methanol poisoning is a rare toxicity that is seen in the form of isolated episodes and intentional ingestion, and sometimes occurs as single epidemies [9,[18][19][20][21]. Therefore, fomepizole is not widely stocked in some hospital pharmacy stocks in comparison…”

Electrocardiographic Manifestations in Acute Methanol Poisoning Cannot Predict Mortality

“…Clinical guidelines for methanol poisoning management recommend using an antidote (ethanol or fomepizole), intravenous (IV) sodium bicarbonate, folic or folinic acid, and often haemodialysis (1, 2, 13). This poisoning can be intentional and unintentional, isolated and epidemic (7,11,12,(14)(15)(16)(17) (12,(18)(19)(20). To date, several studies have been performed to identify the prognostic factors of mortality in methanol poisoning (5, 7, 11, 14-16, 18, 20, 21).…”

“…Sanaei-Zadeh H, et al ECG AS MORTALITY PREDICTOR IN METHANOL POISONING Arh Hig Rada Toksikol 2013;64:265-271 Formate is a toxic metabolite of methanol that causes acidosis and inhibits cell cytochromes (1-3). The clinical picture of acute methanol poisoning includes gastrointestinal, visual, and nervous system signs and symptoms such as headache, dizziness, nausea, vomiting, abdominal pain, visual disturbances, coma, respiratory arrest, seizure, blindness, gastrointestinal haemorrhage, putaminal haemorrhage and infarction, and pancreatitis (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). Diagnosis is based on these clinical signs and symptoms, acidbase status, direct serum methanol levels and/or serum formate, and anion and osmolal gaps (4).…”

“…Clinical guidelines for methanol poisoning management recommend using an antidote (ethanol or fomepizole), intravenous (IV) sodium bicarbonate, folic or folinic acid, and often haemodialysis (1,2,13). This poisoning can be intentional and unintentional, isolated and epidemic (7,11,12,(14)(15)(16)(17). In Iran, alcohol consumption is banned and methanol poisoning is usually associated with illegal consumption of methanol mixed with other alcohols, including smuggled alcohol, homemade liquor, pharmaceutical ethanol preparations, or industrial alcohol (containing a mixture of varying percentages of ethanol and methanol with colour additives) (12,(18)(19)(20).…”