Phosphorus-Enriched Hemodialysis for the Treatment of Patients with Severe Methanol Intoxication

Abstract

Severe methanol poisoning requires treatment with prolonged and intensive hemodialytic therapy. Such treatment can engender either the de novo development of hypophosphatemia or the worsening of pre-existing hypophosphatemia. Phosphorus-enriched hemodialysis therapy can prevent the occurrence of this complication. We report three patients with severe methanol poisoning who were treated with phosphorus-enriched hemodialysis. Prevention or treatment of hypophosphatemia was successfully achieved with this dialytic technique.

Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

“…10, 13 Both methanol and formate are small molecules (molecular weights 32 and 46 g/mol, respectively) with a volume of distribution 0.6–0.7 l/kg for methanol 14 and 0.5 l/kg for formate, 9 and no protein binding. 5 Extensive toxicokinetic data exist on the capacity of IHD to remove methanol, 5, 15, 16, 17, 18, 19, 20 although the evidence is scarce for formate removal. 9, 21, 22 There are no studies evaluating both the effects on methanol and formate kinetics with continuous modes of elimination (CVVHD/HDF) and only one that compared the efficacy of continuous and intermittent modes of dialysis.…”

Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks

“…Intermittent (IHD) or extended daily hemodialysis (EDD) and continuous veno-venous hemofiltration, hemodialysis, or hemodiafiltration (CRRT) are all commonly used [20–22]. There are various reports providing data on the superiority of IHD regarding the rate of elimination of both methanol and formate [23–25], as well as correction of the acidemia [26].…”

Using disodium monohydrogen phosphate to prepare a phosphate‐enriched hemodialysate

“…Such treatments were employed on an acute, short-term basis only. 1 Since the exact composition of such proprietary phosphate preparations commercially available around the world are often unknown, it would seem unwise to use these products for dialysate enrichment on a long-term basis. 2 In an attempt to devise a simple method of preparing phosphate-enriched hemodialysate, we added 15.68 g (58.5 mmol) of powder disodium monohydrogen phosphate (Na2HPO4.7H2O, MW 268) (obtained from Sigma Company, St. Louis, MI, USA) to 1 L of the acid concentrate of a conventional 45X dilution (i.e., 45-fold of the volume of the acid concentrate is needed to reach the final desired dialysate volume through the use of an acid concentrate: bicarbonate concentrate: water ratio of 1:1.72:42.28), 3,4 dual-concentrate, bicarbonate-based dialysate delivery machine (Fresenius 2008K dialysis machine, Fresenius USA, Walnut Creek, CA, USA).…”

“…We read the article "Platelet-to-lymphocyte(P/L) ratio better predicts inflammation than neutrophil-to-lymphocyte(N/L) ratio in end-stage renal disease patients (ESRD)" written by Turkmen et al 1 They concluded that inflammation markers including P/L ratio, N/L ratio, hs-CRP, IL-6, and TNF-α were significantly increased in peritoneal dialysis patients when compared with hemodialysis patients. P/L ratio was also positively correlated with N/L ratio, IL-6, and TNF-α levels.…”