title: Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS).
abstract: BACKGROUND
  Poisoning with methanol and ethylene glycol can cause serious morbidity and mortality. Specific treatment involves the use of antidotes (fomepizole or ethanol) with or without extracorporeal elimination techniques.
  
  
  METHODS
  A prospective audit of patients with methanol or ethylene glycol poisoning reported by telephone to the National Poisons Information Service (NPIS) in the UK was conducted during the 2010 calendar year and repeated during the 2012 calendar year. The study was conducted to determine the frequency of clinically significant systemic toxicity and requirement for antidote use and to compare outcomes and rates of adverse reaction and other problems in use between ethanol and fomepizole.
  
  
  RESULTS
  The NPIS received 1315 enquiries involving methanol or ethylene glycol, relating to 1070 individual exposures over the 2-year period. Of the 548 enquiries originating from hospitals, 329 involved systemic exposures (enteral or parenteral as opposed to topical exposure), of which 216 (66%) received an antidote (204 for ethylene glycol and 12 for methanol), and 90 (27%) extracorporeal treatment (86 for ethylene glycol and 4 for methanol). Comparing ethanol with fomepizole, adverse reactions (16/131 vs. 2/125, p < 0.001) and administration errors, lack of monitoring, or inappropriate use (45/131 vs. 6/125, p < 0.0001) were reported more commonly, whereas non-availability and inadequate stocks were reported less commonly (6/125 vs. 33/131, p < 0.0001). Eight fatalities and complications or sequelae occurred in 21 patients. Poor outcome (death, complications, or sequelae) was significantly associated with older age, higher poisoning severity scores, and lower pH on admission (p < 0.001).
  
  
  CONCLUSIONS
  Systemic poisoning with ethylene glycol or methanol results in hospitalisation at least 2-3 times per week on average in the UK. No difference in outcome was detected between ethanol and fomepizole-treated patients, but ethanol was associated with more frequent adverse reactions.
authors.affiliation: a NPIS (Newcastle Unit) , Regional Drug and Therapeutics Centre , Newcastle , UK ;
authors.forename: Ruben H K
authors.initials: RH
authors.lastname: Thanacoody
authors.affiliation: a NPIS (Newcastle Unit) , Regional Drug and Therapeutics Centre , Newcastle , UK ;
authors.forename: Claire
authors.initials: C
authors.lastname: Gilfillan
authors.affiliation: b NPIS (Birmingham Unit) , City Hospital , Birmingham , UK ;
authors.forename: Sally M
authors.initials: SM
authors.lastname: Bradberry
authors.affiliation: c NPIS (Cardiff Unit) , University Hospital Llandough , Cardiff , UK ;
authors.forename: Jeremy
authors.initials: J
authors.lastname: Davies
authors.affiliation: d NPIS (Edinburgh Unit) , Royal Infirmary , Edinburgh , UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Jackson
authors.affiliation: b NPIS (Birmingham Unit) , City Hospital , Birmingham , UK ;
authors.forename: Allister J
authors.initials: AJ
authors.lastname: Vale
authors.affiliation: c NPIS (Cardiff Unit) , University Hospital Llandough , Cardiff , UK ;
authors.forename: John P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: d NPIS (Edinburgh Unit) , Royal Infirmary , Edinburgh , UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: a NPIS (Newcastle Unit) , Regional Drug and Therapeutics Centre , Newcastle , UK ;
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D019468:Disease Management; D000431:Ethanol / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D000077604:Fomepizole; D006760:Hospitalization; D006801:Humans; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011041:Poisoning / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D019855:Ethylene Glycol; D000432:Methanol
keywords: Antidote; audit; ethanol; ethylene glycol; fomepizole; methanol; poisoning