Abstract
BackgroundThe incidence of methanol (CH3OH) intoxication differs enormously from country to country. Methanol intoxication is extremely rare in the Dutch population. Even a low dose can already be potentially lethal. Patients are conventionally treated with hemodialysis. Therefore we'd like to present a report of a foreign sailor in Rotterdam who accidentally caused himself severe methanol intoxication, with a maximum measured concentration of 4.4 g/L.Case presentationThe patient presented with hemodynamic instability and severe metabolic acidosis with pH 6.69. The anion gap was 39 mmol/L and the osmol gap 73 mosmol/kg. Treatment with ethanol and continuous venovenous hemodiafiltration (CVVH-DF) was initiated. Despite the hemodynamic instability it is was possible to achieve rapid correction of pH and methanol concentration with CVVH-DF while maintaining a stable and therapeutic ethanol serum concentration. Despite hemodynamic and acid-base improvement, our patient developed massive cerebral edema leading to brain death. Permission for organ donation was unfortunately not ascertained.ConclusionsWe conclude that in a hemodynamic instable situation high methanol concentrations and methanol-induced derangements of homeostasis are safely and effectively treated with CVVH-DF and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area.
Highlights
The incidence of methanol (CH3OH) intoxication differs enormously from country to country
We conclude that in a hemodynamic instable situation high methanol concentrations and methanolinduced derangements of homeostasis are safely and effectively treated with continuous venovenous hemodiafiltration (CVVH-DF) and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area
The patient was treated with CVVH-DF and ethanol infusions to block the alcohol dehydrogenase (ADH)
Summary
The incidence of methanol (CH3OH) intoxication differs enormously from country to country. Conclusions: We conclude that in a hemodynamic instable situation high methanol concentrations and methanolinduced derangements of homeostasis are safely and effectively treated with CVVH-DF and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area. Hemodialysis in combination with ethanol or fomipezole, a costly but powerful alcohol dehydrogenase (ADH) blocker is the first choice treatment in case of a severe intoxication [6,7].
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.