Fatal Transdermal Methanol Intoxication: A Case Report and Review of Literature

Abstract

234etanol, odunun distilasyonu ile elde edilen, kimya endüstrisinde sıklıkla kullanılan, çözücü özelliği taşıyan, renksiz, kokusuz ve acı bir alkol çeşididir. Çeşitli solventler, boya-leke çıkarıcılar, antifirizler, araba camı yıkama sıvıları, kolonya ve ispirto metanol içeren sıvılar-dır. Metanolün kendisi toksik değilse de metabolitleri toksiktir. Alkol dehidrojenaz tarafından formaldehite ve takiben formik aside metabolize edilir. Bu metabolitler metabolik asidoz, körlük, kardiovasküler instabilite, böbrek yetmezliği ve ölüme neden olabilen metanol toksitesinden sorumludur. İntoksikasyon sıklıkla kaza ya da intihar amaçlı oral alımdan sonra olur.1 Ancak oldukça nadiren, inhalasyon, plasental ya da cilt yoluyla dolaCilt Yoluyla Gelişen Fatal Metanol Zehirlenmesi: Olgu Sunumu ve Literatür Derlemesi Ö ÖZ ZE ET T Me ta nol, renk siz, ber rak, ko ku su ve ta dı eta no le ben ze yen, çö zü cü ve te miz lik mad de si birçok kim ya sa lın üre ti min de kul la nı lan ol duk ça tok sik bir mo le kül dür. Cid di me ta nol ze hir len me si, bu mad de le rin in ti har gi ri şi mi ve ya ka za ra çö zü cü le rin oral yol dan alın ma sı ile ge liş mek te dir. Transder mal yol la ge li şen me ta nol ze hir len me si ol duk ça az sa yı da has ta da ra por edil miş tir. Me ta nol zehir len me si nin be lir ti le ri gör me bo zuk lu ğu, be yin öde mi, so lu num yet mez li ği ne ne den olan san tral si nir sis te mi dep res yo nu ve cid di me ta bo lik asi doz dur. Bu ra por da, bi lin cin de bo zul ma, de rin ve hız lı so lu num tab lo suy la acil ser vi se ge ti ri len, cilt yo luy la ge li şen ve fa tal sey re den me ta nol in toksi kas yo nu sap ta nan 57 ya şın da bir ba yan has ta su nul muş tur. Ay nı za man da me ta nol ze hir len me siyle il gi li li te ra tür ge niş bir şekil de göz den ge çi ril miş tir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Beyin ödemi; asidoz; böbrek diyalizi; zehirlenme A AB BS S T TR RA AC CT T Methanol is an extremely toxic molecule. It is clear, colorless, odorless and has a taste similar to ethanol, and utilized to produce a number of cleaning substances and chemicals. Serious methanol intoxication developeds either with accidental ingestion or after suicidal attemps. Transdermal methanol intoxication has been reported only in a few patients. The signs of methanol intoxications are visual impairment, brain edema, central nervous system depression leading to respiratory insufficiency and severe metabolic acidosis. A 57-year-old female patient admitted to emergency room with impaired consciousness, tachypnea and deep breathing was presented in this report. In addition, the literature on methanol intoxication was reviewed.

A Rare Case of Transdermal Methanol Intoxication

“…Methanol intoxication is generally seen after oral intake, but although rare, some cases of poisoning have been reported as a result of transdermal absorption (1)(2)(3)(4). As in our case, especially when a history of oral methanol ingestion does not exist, diagnosis of methanol intoxication may be delayed (2,3).…”

“…As in our case, especially when a history of oral methanol ingestion does not exist, diagnosis of methanol intoxication may be delayed (2,3). Even if transdermal methanol poisoning seems rare, local application of methylated spirit is traditionally used for pain relief in some rural regions of Turkey (1)(2)(3)(4). A diagnosis of methanol intoxication should be considered in patients with high anion gap metabolic acidosis who have visual symptoms and consciousness disturbances.…”

“…A latent period of 12-24 hours (until methanol is transformed to its toxic metabolites) often follows methanol ingestion and signs and symptoms may vary depending on the methanol intake path (1,2). Most patients suffer from nausea, vomiting, headache, weakness, and visual loss, and changes in the affected areas may be seen in patients with dermal exposure (1). Large amounts of methanol ingestion may result in seizures, stupor, coma, and even death (2).…”

Accidental Transdermal Methanol Poisoning: Diffificulties and Suggestions in Therapy Case Report

“…As regards to these difficulties most of the reported cases include post mortem findings. [4][5][6][7][8] This report has a target on highlighting the importance of diagnosis and management of methanol poisoning in a case that methanol was transdermally ingested and the patient was completely ignorant of its use. Our patient used a high methanol solvent-containing dressing to cure selulitis in her leg and skin penetration seriously affected her.…”

Toxicity and suicidal tendency linked to the antiepileptic medications

“…Being of narrow therapeutic windows, they are liable to cause intoxication even at the therapeutic doses. In addition, acute toxicity caused by antiepileptic drugs can result from suicidal intake (Gök, 2006).…”