Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, Iran.
J Med Toxicol. 2011 Sep;7(3):189-94. doi: 10.1007/s13181-011-0142-x.
Methanol poisoning is seen in the form of isolated episodes, or intentional ingestion and epidemics. Despite its efficient treatment, methanol poisoning has high morbidity and mortality rates. So far, several studies have been performed to identify the prognostic factors in methanol poisoning. Recently, during the treatment of patients with methanol poisoning, we observed that patients' blood glucose levels were high on presentation to the hospital, particularly in those who expired. Through a literature search, we found that no studies have been performed on blood glucose levels or hyperglycemia in methanol poisoning. Therefore, the present retrospective study was done as a preliminary investigation to understand whether there was a meaningful relationship between methanol poisoning and blood glucose level on presentation, and also if hyperglycemia could be considered as a prognostic factor for mortality. In this retrospective study, a review of the hospital charts was performed for all patients who were treated for methanol poisoning from March 2003 to March 2010 in two hospitals in Tehran, Iran. Those with definitive diagnosis of methanol poisoning, no history of diabetes mellitus, and normal or low body mass index (<25) were included. Patients' demographic information, clinical manifestations, time elapsed between ingestion and presentation, blood glucose level on presentation (before treatment), results of arterial blood gas analysis, and the clinical outcome were recorded. Statistical analysis was done using SPSS software (version 17, Chicago, Illinois, USA) and application of Mann-Whitney U test, Pearson's chi-square test, Pearson correlation coefficient (r), receiver operating characteristic (ROC) curve, and logistic regression. P values less than 0.05 were considered as the statistically significant levels. Ninety-five patients with methanol poisoning met the inclusion criteria and were included in the study. Of these, 91 (96%) were male and 4 (4%) were female. Mean age was 31.61 ± 14.3 years (range, 13 to 75). Among the 95 patients, 68 survived (72%) and 27 expired (28%). Median blood glucose level was 144 mg/dL (range, 75 to 500). There was no significant statistical correlation between blood glucose level and time of treatment, age, pCO(2), or serum bicarbonate concentration, but blood glucose level had a statistically significant correlation with pH (r = -0.242, P = 0.02) and base deficit (r = 0.230, P = 0.03). The mean blood glucose level was 140 ± 55 and 219 ± 99 mg/dL in the survivor and non-survivor patients, respectively (P < 001). Considering the cutoff level of 140 mg/dL for blood glucose and using logistic regression analysis, and adjusting according to the admission data with significant statistical difference in the two study groups, the odds ratio for hyperglycemia as a risk factor for death was 6.5 (95% confidence interval = 1.59-26.4). Our study showed that blood glucose levels were high in methanol poisoning and even higher in those who died in comparison with the survivors. Therefore, hyperglycemia might be a new prognostic factor in methanol poisoning, but further studies are needed to determine whether controlling hyperglycemia has therapeutic consequences.
甲醇中毒表现为孤立发作、故意摄入和流行。尽管治疗效果显著，但甲醇中毒的发病率和死亡率仍然很高。迄今为止，已经有多项研究旨在确定甲醇中毒的预后因素。最近，在治疗甲醇中毒患者的过程中，我们观察到患者入院时的血糖水平较高，尤其是那些死亡的患者。通过文献检索，我们发现没有研究涉及甲醇中毒患者的血糖水平或高血糖。因此，本回顾性研究旨在初步探讨甲醇中毒与入院时的血糖水平之间是否存在有意义的关系，以及高血糖是否可以作为死亡率的预后因素。在这项回顾性研究中，对 2003 年 3 月至 2010 年 3 月在伊朗德黑兰的两家医院接受甲醇中毒治疗的所有患者的病历进行了回顾。纳入标准为：明确诊断为甲醇中毒、无糖尿病史、身体质量指数正常或偏低（<25）。记录患者的人口统计学信息、临床表现、摄入与就诊之间的时间间隔、就诊时的血糖水平（治疗前）、动脉血气分析结果和临床转归。采用 SPSS 软件（版本 17，芝加哥，伊利诺伊州，美国）进行统计学分析，并应用曼-惠特尼 U 检验、皮尔逊卡方检验、皮尔逊相关系数（r）、受试者工作特征（ROC）曲线和逻辑回归。P 值<0.05 被认为具有统计学意义。符合纳入标准的 95 例甲醇中毒患者被纳入本研究。其中，91 例（96%）为男性，4 例（4%）为女性。平均年龄为 31.61±14.3 岁（范围 13 至 75 岁）。95 例患者中，68 例存活（72%），27 例死亡（28%）。中位数血糖水平为 144mg/dL（范围 75 至 500mg/dL）。血糖水平与治疗时间、年龄、pCO2 或血清碳酸氢盐浓度之间无显著统计学相关性，但与 pH 值（r=-0.242，P=0.02）和碱缺失（r=0.230，P=0.03）具有统计学相关性。幸存者和非幸存者的平均血糖水平分别为 140±55mg/dL 和 219±99mg/dL（P<0.001）。考虑到血糖水平的 140mg/dL 截断值，并使用逻辑回归分析，并根据两组研究中具有显著统计学差异的入院数据进行调整，高血糖作为死亡风险因素的优势比为 6.5（95%置信区间=1.59-26.4）。我们的研究表明，甲醇中毒患者的血糖水平较高，与幸存者相比，死亡患者的血糖水平更高。因此，高血糖可能是甲醇中毒的一个新的预后因素，但需要进一步研究以确定控制高血糖是否具有治疗意义。
