title: Compliance with poison center fomepizole recommendations is suboptimal in cases of toxic alcohol poisoning.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois 60611, USA. mmycyk@northwestern.edu
authors.forename: Mark B
authors.initials: MB
authors.lastname: Mycyk
authors.forename: Carol
authors.initials: C
authors.lastname: DesLauriers
authors.forename: Jessica
authors.initials: J
authors.lastname: Metz
authors.forename: Brandon
authors.initials: B
authors.lastname: Wills
authors.forename: Suzan S
authors.initials: SS
authors.lastname: Mazor
mesh_terms: 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
chemical_list: D000931:Antidotes; D004791:Enzyme Inhibitors; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000426:Alcohol Dehydrogenase; D019855:Ethylene Glycol; D000432:Methanol