Rathi Manish, Sakhuja Vinay, Jha Vivekanand
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Hemodial Int. 2006 Jan;10(1):8-14. doi: 10.1111/j.1542-4758.2006.01169.x.
Extracorporeal treatments have an important role in the management of several types of poisonings and drug overdosage. Methanol poisoning is a major problem in large parts of the developing world, especially among the economically depressed, and is responsible for innumerable deaths annually. Poisoning occurs when methanol, a contaminant of bootlegged alcohol, is consumed unknowingly. Toxicity is related to formaldehyde and formic acid formed as a result of methanol metabolism, and presents as metabolic acidosis, visual impairment, neurological manifestations, and shock. Initial symptoms are nonspecific and masked by the inebriating effect of ethanol. Appropriate management requires immediate administration of ethanol, which competitively inhibits methanol metabolism and prevents the generation of toxic formic acid and hemodialysis to achieve expeditious clearance of methanol and formic acid. Fomepizole, a safer metabolic inhibitor, has largely replaced ethanol in the western world. Delay in seeking medical attention contributes to mortality and morbidity. We report on a patient who presented to us 8 hr after consumption of countrymade alcohol with symptoms of methanol poisoning. Prompt administration of ethanol and institution of hemodialysis resulted in complete reversal of all manifestations.
体外治疗在多种中毒和药物过量的处理中发挥着重要作用。甲醇中毒在发展中世界的大部分地区是一个主要问题，尤其是在经济贫困人群中，每年导致无数人死亡。当甲醇（一种私酿酒中的污染物）被无意中摄入时就会发生中毒。毒性与甲醇代谢产生的甲醛和甲酸有关，表现为代谢性酸中毒、视力损害、神经学表现和休克。初始症状不具特异性，且被乙醇的醉酒作用所掩盖。恰当的处理需要立即给予乙醇，其可竞争性抑制甲醇代谢并防止有毒甲酸的生成，同时进行血液透析以迅速清除甲醇和甲酸。在西方世界，更安全的代谢抑制剂甲吡唑已在很大程度上取代了乙醇。延迟就医会增加死亡率和发病率。我们报告了一名在饮用自制酒8小时后出现甲醇中毒症状前来就诊的患者。及时给予乙醇并进行血液透析使所有症状完全逆转。
