Abstract
In May and June 2020, an outbreak of methanol poisoning arose in the southwest United States linked to ingestion of contaminated hand sanitizer imported during the coronavirus disease 2019 pandemic, ultimately resulting in over a dozen hospitalizations and at least four deaths in New Mexico and Arizona. In this report, we describe one of these cases in which profound methanol intoxication was successfully treated with the Tablo® Hemodialysis System, the first reported case of toxic alcohol poisoning treated with this novel device. We carry out a formal regression analysis of the serial methanol levels obtained in this case to conservatively estimate that intermittent hemodialysis with Tablo achieved a clearance of methanol of 239 mL/min (95% confidence interval, 173–305 mL/min), a clearance that is well within the previously published standard of care. We conclude by reviewing both the treatment of toxic alcohol poisoning and the determinants of small molecule clearance with hemodialysis, emphasizing the importance of optimizing the dialytic treatment of intoxications with extended treatment times and the use of high-efficiency dialyzers.
Highlights
Toxic alcohol poisoning continues, even in the twentyfirst century, to account for dozens of deaths annually in the United States (US) [1, 2]
University of New Mexico, Albuquerque, NM 87131, USA Full list of author information is available at the end of the article hemodialysis (IHD) using the Tablo® Hemodialysis System (Outset Medical, San Jose, CA, USA), the first reported case of toxic alcohol poisoning treated with this novel device
This led to an outbreak of methanol poisoning which resulted in 15 known hospitalizations and at least four deaths in New Mexico and Arizona in May and June of 2020 [2, 13]
Summary
Even in the twentyfirst century, to account for dozens of deaths annually in the United States (US) [1, 2]. Following the three sessions of HD, his anion gap, osmolar gap, and blood gas normalized His methanol levels decreased and became undetectable on hospital day 4. The renal clearance of formate, though variable and pH-dependent, is much higher, consistently reported at > 170 mL/min, and the additional clearance of formate by IHD appears small (and of unclear clinical relevance) relative to endogenous clearance [4, 5, 8,9,10,11] In this case, if we conservatively assume an endogenous methanol half-life of 52 h, the serum level of methanol of 64.9 mmol/L (208 mg/dL) at approximately 8 am on day 2 would have decayed to approximately 62.4 mmol/L (200 mg/dL) by the start of dialysis 3 h later. Lab WBC Hemoglobin Hematocrit MCV Platelets INR Sodium Potassium Chloride Total CO2 BUN Creatinine Glucose Calcium Phosphorus Magnesium Anion gap Total protein Albumin AST* ALT Alkaline phosphatase Total bilirubin Ammonia* Serum osmolality Lactate Lipase* Troponin I Creatine kinase Ethanol Acetaminophen Salicylate Ketones by urinalysis Urine amphetamine screen Urine barbiturate screen Urine benzodiazepine screen Urine cannabinoid screen Urine cocaine screen Urine methadone screen Urine opiate screen pH pCO2 pO2 Calculated HCO3
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
