Appendix 1. Case Study: Methanol Mass Poisoning Outbreak in the Czech Republic: Diagnosis, Treatment and Outcome

Abstract

Methanol outbreaks are a global public health issue, with poor outcomes associated with delayed treatment. We report the data from the mass methanol poisoning outbreak in the Czech Republic in 2012–2014. From a total of 137 poisoned subjects, 31 died outside the hospital and 106 were hospitalized. Of these, 83 patients survived. The total and hospital mortality rates were 39% and 22%, respectively. Arterial blood pH under 7.0, negative serum ethanol and coma on admission were the independent parameters predicting death. We found a positive association between out-of-hospital ethanol administration and improved treatment outcome. Both antidotes, fomepizole and ethanol, may be considered for alcohol dehydrogenase blockade in hospital without limitations. Intermittent haemodialysis is superior to continuous modalities in terms of the rate of elimination of both methanol and formate. The prevalence of long-term visual sequelae after methanol poisoning was significantly higher than the prevalence of visual disturbances at the time of discharge from hospital. Altogether, 40% of examined survivors had abnormal morphological and functional findings complying with the criteria of long-term visual damage 3–8 months after discharge. The prevalence of long-term central nervous system sequelae was clearly underestimated at discharge from hospital, as magnetic resonance examination revealed brain lesions in 52% of the survivors.