The management of severe toxic alcohol ingestions at a tertiary care center after the introduction of fomepizole.
BACKGROUND
Ethylene glycol and methanol ingestions are relatively uncommon but potentially lethal poisonings. Recent trials have demonstrated that fomepizole effectively blocks alcohol dehydrogenase (ADH) in toxic alcohol overdoses, and may eliminate the need for emergent hemodialysis and intensive care unit admission. However, controversy remains in the role of fomepizole in clinical practice. The purpose of this study was to describe the presentation, management and clinical course of toxic alcohol ingestions at a tertiary care referral center after the introduction of fomepizole to hospital formulary.


METHODS
Data was collected on all patents treated for toxic alcohol ingestions for a 1-year period in a tertiary care referral center. Patients who received fomepizole or ethanol infusions, or who underwent hemodialysis were identified by ED, pharmacy, hemodialysis and ICU databases. The patients' medical records were reviewed, and data was recorded on a predetermined computerized data collection form.


RESULTS
Overall, twenty (20) toxic ingestions (14 methanol; 6 ethylene glycol) were identified over the one year period. Fomepizole was used for ADH blockade in 12/20 cases; ETOH infusions in 15/20 cases (combined ETOH and fomepizole use in 7/20). The majority of toxic alcohol exposures were admitted to an intensive care unit (19/20) and received emergent hemodialysis (19/20). All patients were discharged from hospital alive.


CONCLUSIONS
Patients with methanol and ethylene glycol ingestions who presented to our centers had significant toxicity and received both HD and ICU admission. Further research is required to determined if the method of ADH blockade affects the need for hemodialysis or ICU admission in toxic alcohol ingestions.
Green
Robert
R
Department of Emergency Medicine, Division of Critical Care Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2Y9. greenrs@dal.ca
D000328:Adult; D000426:Alcohol Dehydrogenase / Q000037:antagonists & inhibitors; D000931:Antidotes / Q000627:therapeutic use*; D016208:Databases, Factual; D000431:Ethanol / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D000077604:Fomepizole; D006801:Humans; D008297:Male; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011041:Poisoning / Q000628:therapy; D011720:Pyrazoles / Q000627:therapeutic use*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012997:Solvents / Q000506:poisoning*
D000931:Antidotes; D011720:Pyrazoles; D012997:Solvents; D000431:Ethanol; D000077604:Fomepizole; D000426:Alcohol Dehydrogenase; D019855:Ethylene Glycol; D000432:Methanol