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. 2020 Feb 7;13(1):6.
doi: 10.1186/s12245-020-0264-5.

Methanol outbreak: a Malaysian tertiary hospital experience

J Md Noor  1 , R Hawari  2 , M F Mokhtar  3 , S J Yussof  2 , N Chew  2 , N A Norzan  2 , R Rahimi  4 , Z Ismail  5 , S Singh  2 , J Baladas  2 , N H Hashim  2 , M I K Mohamad  3 , M D Pathmanathan  6
Affiliations

Methanol outbreak: a Malaysian tertiary hospital experience

J Md Noor et al. Int J Emerg Med. .

Abstract

Introduction: Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources.

Methodology: A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre.

Result: A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications. Osmolar gap and lactate had strong correlations with patient's mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable.

Conclusion: The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.

Keywords: Dialysis; Methanol; Outbreak; Poisoning; Toxicity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Age range of the patients
Fig. 2
Fig. 2
Median values of laboratory investigations
Fig. 3
Fig. 3
Median value of anion and osmolar gap
See this image and copyright information in PMC

References

    1. Medina E, R. R. R . Methanol safe handling manual. 4 2017.
    1. Kraut J. Approach to the treatment of methanol intoxication. Am J Kidney Dis. 2016;68(1):161–167. doi: 10.1053/j.ajkd.2016.02.058. - DOI - PubMed
    1. Mégarbane B. Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open Access Emergency Med. 2010;2:67–75. doi: 10.2147/OAEM.S5346. - DOI - PMC - PubMed
    1. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol. 2007;45(2):152–157. doi: 10.1080/15563650600956329. - DOI - PubMed
    1. Galvez-Ruiz A, Elkhamary SM, Asghar N, Bosley TM. Visual and neurologic sequelae of methanol poisoning in Saudi Arabia. Saudi Med J. 2015;36(5):568–574. doi: 10.15537/smj.2015.5.11142. - DOI - PMC - PubMed

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