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Epidemic poisoning with methanol in Estonia: experience of intensive care

In September 2001, 147 patients were admitted to Pärnu county hospital in Estonia with suspicion of acute methanol poisoning due to consumption of illegal alcohol. From these patients, 35 (22 male and 13 female, age from 19 to 74, mean 41 years) were transferred into Tartu University Clinics for further intensive care, particularly for hemodialysis. Most of the transferred patients appeared in coma, 29 were in shock. First-line therapy (before and during transport) consisted of artificial ventilation, fluid resuscitation, vasopressors, if needed, and i.v. infusion of 10% ethylalcohol as an antidote. Arterial pH prior to transport was in range from 6.49 to 7.29, and base excess from -12 to -30. In average 690 mmoles (from 200 to 1700 mmoles) of sodium bicarbonate was administered before dialysis for management of acidemia. In our department, 30 patients were treated with single hemodialysis for 6 hours, while three patients underwent continuous venovenous hemodialysis for 12 to 16 hours. The blood level of methanol was in range from 0.24 to 5.9 (mean 1.67) mg/dl before dialysis. After discontinuation of the dialysis, the methanol level remained between 0.05 and 1.6 (mean 0.59) mg/dl, and infusion of 10% ethyl alcohol was continued until methanol level below 0.3 mg/dl was detected. Neurological impairment was evident in seven patients after dialysis. In CT-scans, intracerebral haemorrhages, white-matter lesions, and severe brain oedema were the common findings. Four patients, who complained visual disturbances in immediate post-dialysis period, were treated with hyperbaric oxygenation, and in three of them the symptoms were effectively reversed. Overall, from 35 patients six died (mortality 17%), two remained with persistent neurological disability (encelopathy, coma), while 27 patients (77%) were discharged from hospital in normal health status.

In conclusion, our experience demonstrates the importance of intravenous ethanol administration, hemodialysis, and hyperbaric oxygenation in the management of acute methanol poisoning.

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Sarapuu, S., Eerme, M., O'Konnel, N. et al. Epidemic poisoning with methanol in Estonia: experience of intensive care. Crit Care 6 (Suppl 1), P167 (2002).

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