title: Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study.
abstract: INTRODUCTION. Thorough prognostic and metabolic studies of methanol poisonings are scarce. Our aims were to evaluate the factors associated with sequelae and death from methanol poisoning, to develop a simple risk-assessment chart to evaluate factors associated with sequelae and death from methanol poisoning, and to compare the antidotes ethanol and fomepizole. PATIENTS AND METHODS. We present a retrospective observational case series of methanol-poisoned patients from Norway (1979 and 2002-2005), Estonia (2001) and Tunisia (2003/2004), and patients from two different centers in Iran (Teheran 2004-2009 and Mashhad 2009-2010) who were identified by a positive serum methanol and had a blood acid-base status drawn on admission. The patients were divided into different groups according to their outcome: Survived, survived with sequelae, and died. RESULTS. A total of 320 patients were identified and 117 were excluded. Of the remaining 203 patients, 48 died, and 34 were discharged with neurological sequelae. A pH < 7.00 was found to be the strongest risk factor for poor outcome, along with coma (Glasgow Coma Scale (GCS) < 8) and a pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00. More patients died despite hyperventilation (low pCO(2)) in the ethanol group. CONCLUSIONS. Low pH (pH < 7.00), coma (GCS < 8), and inadequate hyperventilation (pCO(2) ≥ 3.1 kPa in spite of a pH < 7.00) on admission were the strongest predictors of poor outcome after methanol poisoning. A simple flow-chart may help identify the patients associated with a poor outcome.
authors.affiliation: Department of Anesthesiology and ICU, University of Tartu, Pärnu County Hospital, Estonia.
authors.forename: Raido
authors.initials: R
authors.lastname: Paasma
authors.forename: Knut Erik
authors.initials: KE
authors.lastname: Hovda
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.forename: Nozha
authors.initials: N
authors.lastname: Brahmi
authors.forename: Reza
authors.initials: R
authors.lastname: Afshari
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Dag
authors.initials: D
authors.lastname: Jacobsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003243:Consciousness; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D000077604:Fomepizole; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011379:Prognosis; D011720:Pyrazoles / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000432:Methanol