Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning.
BACKGROUND
Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined.


OBJECTIVE
We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning.


METHODS
The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO3-, 0.01 unit arterial blood pH, and the total time for correction of HCO3-were determined in IHD- and CRRT-treated patients.


RESULTS
Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p = 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO3-correction correlated with arterial blood pH (r= -0.511; p = 0.003) and creatinine (r = 0.415; p = 0.020). There was association between the time to HCO3-correction and dialysate/effluent and blood flow rates (r= -0.738; p < 0.001 and r= -0.602; p < 0.001, correspondingly). The mean time for HCO3-to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p = 0.024). The mean increase in HCO3-was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001).


CONCLUSIONS
Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.
a Department of Occupational Medicine, First Faculty of Medicine , Toxicological Information Centre, Charles University and General University Hospital , Prague , Czech Republic.
Sergey
S
Zakharov
a Department of Occupational Medicine, First Faculty of Medicine , Toxicological Information Centre, Charles University and General University Hospital , Prague , Czech Republic.
Daniela
D
Pelclova
a Department of Occupational Medicine, First Faculty of Medicine , Toxicological Information Centre, Charles University and General University Hospital , Prague , Czech Republic.|b First Faculty of Medicine , Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University and General University Hospital , Prague , Czech Republic.|c J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i , Prague , Czech Republic.
Tomas
T
Navratil
d First Faculty of Medicine , Institute of Biophysics and Informatics, Charles University and General University Hospital , Prague , Czech Republic.
Jaromir
J
Belacek
e Department of Internal Medicine , Tomas Bata Regional Hospital, Zlin , Czech Republic.
Jiri
J
Latta
e Department of Internal Medicine , Tomas Bata Regional Hospital, Zlin , Czech Republic.
Michal
M
Pisar
f Department of Anesthesiology , Resuscitation, and Intensive Medicine, General University Hospital , Prague , Czech Republic.
Jan
J
Rulisek
g Department of Anesthesiology and Resuscitation , Znojmo City Hospital , Znojmo, Czech Republic.
Jiri
J
Leps
h Department of Anesthesiology and Resuscitation , Benešov City Hospital, Benešov , Czech Republic.
Pavel
P
Zidek
i Department of Anesthesiology and Resuscitation , Ostrava City Hospital, Ostrava , Czech Republic.
Cyril
C
Kucera
j Department of Anesthesiology and Intensive Medicine , Havířov Hospital, Havířov , Czech Republic.
Robert
R
Bocek
j Department of Anesthesiology and Intensive Medicine , Havířov Hospital, Havířov , Czech Republic.
Miroslav
M
Mazur
k Department of Anesthesiology and Intensive Medicine , Karvina-Raj Hospital , Orlova , Czech Republic.
Zdenek
Z
Belik
l Department of Anesthesiology and Resuscitation , Frydek-Mistek City Hospital, Frydek-Mistek , Czech Republic.
Josef
J
Chalupa
m Department of Internal Medicine , Frydek-Mistek City Hospital, Frydek-Mistek , Czech Republic.
Viktor
V
Talafa
n Department of Anesthesiology and Resuscitation , Kladno City Hospital, Kladno , Czech Republic.
Kamil
K
Kodras
o Department of Anesthesiology and Resuscitation , Masaryk Hospital, Ústínad Labem , Czech Republic.
Daniel
D
Nalos
p Department of Anesthesiology and Intensive Care Medicine , University Hospital Olomouc , Olomouc, Czech Republic.
Ctirad
C
Sedlak
q Department of Internal Medicine , Faculty Hospital Brno , Brno, Czech Republic.
Michal
M
Senkyrik
r Department of Internal Medicine , Ostrava City Hospital, Ostrava , Czech Republic.
Jan
J
Smid
s Department of Clinical Biochemistry , Tomas Bata Regional Hospital, Zlin , Czech Republic.
Tomas
T
Salek
t Medical School, Australian National University , Canberra , Australia.
Darren M
DM
Roberts
u Department of Acute Medicine , The Norwegian CBRNe Centre of Medicine, Oslo University Hospital , Oslo , Norway.
Knut Erik
KE
Hovda
D000138:Acidosis / Q000139:chemically induced* / Q000628:therapy; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D013997:Time Factors
D001639:Bicarbonates; D000432:Methanol
Acidemia; continuous veno-venous hemodialysis; extended daily hemodialysis; intermittent hemodialysis; metabolic acidosis; methanol poisoning