Compliance with poison center fomepizole recommendations is suboptimal in cases of toxic alcohol poisoning.
We sought to examine hospital compliance with poison center antidotal alcohol dehydrogenase inhibition recommendations in cases of ethylene glycol (EG) and methanol (ME) ingestion. A 2-year analysis of all potential EG and ME ingestion cases reported to a regional poison center was conducted. Excluded from analysis were exposures without an ingestion, without a confirmatory EG or ME serum assay, or without complete medical charting. During the study period, 579 EG or ME exposures were reported to the poison center: 133 cases met study eligibility as an ingestion. Of the 133 cases, 102 (77%) had complete data and were included in the analysis. Immediate alcohol dehydrogenase inhibition was recommended by the poison center in 79 of the 102 cases. Fomepizole was recommended in 61/79 (77%); ethanol was recommended as an alternative therapeutic choice in 32/61 (52%) of these cases if fomepizole was not immediately available. Ethanol alone was recommended in 18/79 (23%). Fomepizole was eventually administered in 39/61 (64%) cases where recommended. The mean time to antidote administration was 3 times longer in cases where a choice in antidote was given [57 min (95% confidence interval, 43-70) vs. 146 min (95% confidence interval, 93-200)]. Despite its ease of administration, fomepizole is used less frequently than recommended by poison center staff. Delays to antidote administration occurred more commonly in cases where the poison center gave a choice in antidotal therapy.
Mycyk
Mark B
MB
Department of Emergency Medicine, Northwestern University, Chicago, Illinois 60611, USA. mmycyk@northwestern.edu
DesLauriers
Carol
C
Metz
Jessica
J
Wills
Brandon
B
Mazor
Suzan S
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000426:Alcohol Dehydrogenase / Q000037:antagonists & inhibitors; D000931:Antidotes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D000431:Ethanol / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D000077604:Fomepizole; D019983:Guideline Adherence; D006801:Humans; D007087:Illinois; D007223:Infant; D008297:Male; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011041:Poisoning / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011720:Pyrazoles / Q000627:therapeutic use*; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors
D000931:Antidotes; D004791:Enzyme Inhibitors; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000426:Alcohol Dehydrogenase; D019855:Ethylene Glycol; D000432:Methanol