Green Robert
Department of Emergency Medicine, Division of Critical Care Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2Y9.
Am J Emerg Med. 2007 Sep;25(7):799-803. doi: 10.1016/j.ajem.2007.01.017.
Ethylene glycol and methanol ingestions are relatively uncommon but potentially lethal poisonings. Recent trials have demonstrated that fomepizole effectively blocks alcohol dehydrogenase (ADH) in toxic alcohol overdoses, and may eliminate the need for emergent hemodialysis and intensive care unit admission. However, controversy remains in the role of fomepizole in clinical practice. The purpose of this study was to describe the presentation, management and clinical course of toxic alcohol ingestions at a tertiary care referral center after the introduction of fomepizole to hospital formulary.
Data was collected on all patents treated for toxic alcohol ingestions for a 1-year period in a tertiary care referral center. Patients who received fomepizole or ethanol infusions, or who underwent hemodialysis were identified by ED, pharmacy, hemodialysis and ICU databases. The patients' medical records were reviewed, and data was recorded on a predetermined computerized data collection form.
Overall, twenty (20) toxic ingestions (14 methanol; 6 ethylene glycol) were identified over the one year period. Fomepizole was used for ADH blockade in 12/20 cases; ETOH infusions in 15/20 cases (combined ETOH and fomepizole use in 7/20). The majority of toxic alcohol exposures were admitted to an intensive care unit (19/20) and received emergent hemodialysis (19/20). All patients were discharged from hospital alive.
Patients with methanol and ethylene glycol ingestions who presented to our centers had significant toxicity and received both HD and ICU admission. Further research is required to determined if the method of ADH blockade affects the need for hemodialysis or ICU admission in toxic alcohol ingestions.
乙二醇和甲醇中毒相对不常见，但有潜在致命性。近期试验表明，对于有毒酒精过量摄入，甲吡唑可有效阻断乙醇脱氢酶（ADH），且可能无需进行紧急血液透析和入住重症监护病房。然而，甲吡唑在临床实践中的作用仍存在争议。本研究的目的是描述在三级医疗转诊中心将甲吡唑纳入医院处方集后，有毒酒精摄入的临床表现、治疗及临床病程。
收集某三级医疗转诊中心1年内所有因有毒酒精摄入接受治疗患者的数据。通过急诊科、药房、血液透析和重症监护病房数据库识别接受甲吡唑或乙醇输注或接受血液透析的患者。查阅患者病历，并将数据记录在预先设定的计算机化数据收集表上。
在这一年期间，共识别出20例有毒物质摄入病例（14例甲醇；6例乙二醇）。12/20例使用甲吡唑进行ADH阻断；15/20例进行乙醇输注（7/20例同时使用乙醇和甲吡唑）。大多数有毒酒精暴露患者入住重症监护病房（19/20）并接受紧急血液透析（19/20）。所有患者均康复出院。
到我们中心就诊的甲醇和乙二醇中毒患者毒性显著，均接受了血液透析和入住重症监护病房。需要进一步研究以确定ADH阻断方法是否会影响有毒酒精摄入患者对血液透析或入住重症监护病房的需求。
