title: Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning.
abstract: During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates.
authors.affiliation: Department of Occupational Medicine, Toxicological Information Center, General University Hospital and First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zakharov
authors.affiliation: Department of Occupational Medicine, Toxicological Information Center, General University Hospital and First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pelclova
authors.affiliation: J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i., Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Navratil
authors.affiliation: Institute of Biophysics and Informatics of First Faculty of Medicine of Charles University in Prague, General University Hospital, Prague, Czech Republic.
authors.forename: Jaromir
authors.initials: J
authors.lastname: Belacek
authors.affiliation: Department of Toxicology, Institute of Forensic Medicine and Toxicology, General University Hospital in Prague and of the First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kurcova
authors.affiliation: Department of Toxicology, Institute of Forensic Medicine and Toxicology, General University Hospital in Prague and of the First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Komzak
authors.affiliation: Department of Clinical Biochemistry, Tomas Bata Regional Hospital in Zlin, Zlin, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Salek
authors.affiliation: Department of Internal Medicine, Tomas Bata Regional Hospital in Zlin, Zlin, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Latta
authors.affiliation: Department of Anesthesiology and Resuscitation, Tomas Bata Regional Hospital in Zlin, Zlin, Czech Republic.
authors.forename: Radovan
authors.initials: R
authors.lastname: Turek
authors.affiliation: Department of Anesthesiology and Intensive Care, Hospital Havirov, Havirov, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Bocek
authors.affiliation: Department of Anesthesiology and Resuscitation, City Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: Cyril
authors.initials: C
authors.lastname: Kucera
authors.affiliation: Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jaroslav A
authors.initials: JA
authors.lastname: Hubacek
authors.affiliation: Department of Occupational Medicine, Toxicological Information Center, General University Hospital and First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Fenclova
authors.affiliation: Department of Occupational Medicine, Toxicological Information Center, General University Hospital and First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
authors.forename: Vit
authors.initials: V
authors.lastname: Petrik
authors.affiliation: Department of Anesthesiology and Intensive Care, Regional Hospital Pribram, Pribram, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Cermak
authors.affiliation: Department of Acute Medicine, The Norwegian Center for NBC Medicine, Oslo University Hospital, Ullevaal, Norway.
authors.forename: Knut Erik
authors.initials: KE
authors.lastname: Hovda
mesh_terms: D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D001783:Blood Flow Velocity; D018153:Czech Republic; D005260:Female; D005561:Formates / Q000097:blood*; D006207:Half-Life; D017583:Hemodiafiltration / Q000379:methods; D015312:Hemodialysis Solutions; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D000432:Methanol / Q000097:blood* / Q000506:poisoning*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods
chemical_list: D000931:Antidotes; D005561:Formates; D015312:Hemodialysis Solutions; C030544:formic acid; D000432:Methanol