Kinetics, dialysis systems, adequacy Postdialysis rebound in a case of acute methanol poisoning

Abstract

Introduction: Methanol poisoning can lead to complications that include metabolic acidosis, visual impairment and death. Treatment options include ethanol, fomepizole, and hemodialysis (HD). Objective: To report on the occurrence of post dialysis methanol rebound during treatment. Method and Findings: A 40‐year‐old male with a history of schizophrenia and suicide attempts presented to the emergency room after reportedly ingesting 1 quart of windshield washer fluid. The patient presented with a preliminary blood chemistry of methanol 390 mg/dL, ethanol 48 mg/dL, glucose 93 mg/dL, Na 138 meq/L, K 3.8 meq/L, Cl 98 mmol/L, CO2 26 mmol/L, urea 16 mg/dL, creatinine 1.2 mg/dL, and an anion gap of 14 mmol/L. The patient was started on 1360 mg of fomepizole (12:50 AM) followed by HD for 4 hours. A second dose of fomepizole (900 mg) was administered at 8:00 AM. In addition, another HD session was started at 12:00 PM and continued for 4 hours. A third dose of fomepizole (700 mg) was administered at 8:50 PM. Finally, a third HD session was started the next day at 3:05 PM and lasted 3 hours. Table 1 illustrates methanol levels in relation to each HD session. Findings: Methanol concentration after the first HD increased from 100 mg/dL to 127 mg/dL (27%) in 5 h 20 m. It also increased from 35 mg/dL to 50 mg/dL (43%) 14 h 45 m after the second HD. Conclusions: Close attention must be paid to the potential for post dialysis methanol rebound. It is recommended that methanol levels continue to be monitored for several hours after HD. Methanol levels before and after each hemodialysis Start HD #1 (2:40 AM) End HD #1 (6:40 AM) Start HD#2 (12:00 PM) End HD#2 (4:00 PM) Next Day (6:45 AM) Methanol (mg/dL) 324 100 127 35 50 Rebound 27% 43%