Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning

Abstract

Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012–2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6–32.2) mmol dm−3]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57–21.34; p < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving (p < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85–23.02; p < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission.Graphical abstract

Leukotriene-mediated neuroinflammation, toxic brain damage, and neurodegeneration in acute methanol poisoning

“…In animal models of cerebral, renal, liver, and cardiac ischemia, alcohol exposure was shown to reduce ischemia reperfusion injury and prevent post-ischemic adhesive interactions between leukocytes and endothelial cells which can lead to organ dysfunction and death [51,52]. The patients who received pre-hospital ethanol as a "first aid antidote" before admission to hospital had higher serum LTC4 concentration and had better outcome of poisoning than those with negative serum ethanol on admission, as was shown in our earlier studies [53,54]. Finally, the patients treated with IHD had higher concentration of cys-LTs than those treated with CRRT.…”

Progressive Chronic Retinal Axonal Loss Following Acute Methanol-induced Optic Neuropathy: Four-Year Prospective Cohort Study

“…6,7 A positive serum ethanol concentration prevents formic acid accumulation and acidemia progression and is associated with a better clinical outcome. 5,38 Higher rates of formic acid elimination and acidemia correction during intermittent hemodialysis may be responsible for the association of the mode of dialysis with the rate of chronic axonal loss in our study. 18,39 Chronic retinal axonal loss might be caused by other pathologic conditions that are unrelated to methanol exposure.…”

Aldehyde dehydrogenase 2 polymorphism affects the outcome of methanol poisoning in exposed humans

“…In humans, up to 30% of the consumed methanol is excreted through the respiratory tract, 3% to 5% are excreted unchanged through the sweat and urine . The majority (~60%) of the consumed methanol is, due to its structural similarity to ethanol, metabolised through the same pathway as ethanol (as long as ADH1B activity is not saturated by ethanol, which has a higher affinity to this enzyme than methanol) …”

“…4,5 The majority (~60%) of the consumed methanol is, due to its structural similarity to ethanol, metabolised through the same pathway as ethanol (as long as ADH1B activity is not saturated by ethanol, which has a higher affinity to this enzyme than methanol). 6,7 The alcohol dehydrogenase 1B (ADH1B), the key and rate limiting enzyme of ethyl alcohol/methyl alcohol metabolism, converts ethanol to acetaldehyde and methanol to formaldehyde. Within ADH1B gene, a variant p.Arg48His (c.143G > A; rs1229984) with strong impact on enzyme activity was detected.…”