Kute Vivek B, Godara Suraj M, Shah Pankaj R, Gumber Manoj R, Goplani Kamal R, Vanikar Aruna V, Munjappa Bipin C, Patel Himanshu V, Trivedi Hargovind L
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Ahmedabad, India.
Saudi J Kidney Dis Transpl. 2012 Jan;23(1):37-43.
Methanol is a cheap and potent adulterant of illicit liquors. Hemodialysis (HD) is the best method to rapidly remove both toxic acid metabolites and parent alcohols, and it plays a fundamental role in treating severely poisoned patients. This retrospective study was carried out on 91 patients with detectable serum methanol levels who underwent HD. Because toxic alcohol levels were not immediately available, the initial diagnosis and treatment was based on clinical history with evidence of toxic alcohol intake, presence of high anion metabolic acidosis and/or end organ damage. Patients received bicarbonate, ethanol, according to clinical features and blood gases. Patients underwent HD in the setting of known methanol ingestion with high anion gap metabolic acidosis, or evidence of end-organ damage, regardless of methanol level. HD prescription included large surface area dialyzer (≥ 1.5 m²), blood flow rate of 250-350 mL/min and dialysate flow rate of 500 mL/min for 4-6 h. Between 9 and 11 July 2009, 91 males with mean age 40 ± 8.5 years underwent HD, and 13 patients required a second HD session. Patients consumed 100-500 mL illicit liquors, and symptoms appeared six and 60 h later. Clinical features were gastro-intestinal symptoms (83.5%), visual disturbances (60.4%), central nervous system symptoms (59.3%) and dyspnea (43.9%). Before HD, mean pH was 7.11 ± 0.04 (range 6.70- 7.33) and mean bicarbonate levels were 8.5 ± 4.9 mmol/L (range 2-18). Three patients died due to methanol intoxication. Mortality was associated with severe metabolic acidosis (pH ≤ 6.90), ventilator requirement and coma/seizure on admission (P < 0.001). Timely HD, bicarbonate, ethanol and supportive therapy can be life-saving in methanol intoxication.
甲醇是非法酒类中一种廉价且强效的掺假物质。血液透析（HD）是快速清除有毒酸性代谢产物和母体醇类的最佳方法，在治疗重度中毒患者中发挥着重要作用。本回顾性研究对91例血清甲醇水平可检测且接受血液透析的患者进行。由于无法立即获得有毒酒精水平，初始诊断和治疗基于有毒酒精摄入的临床病史、高阴离子代谢性酸中毒和/或终末器官损伤的证据。患者根据临床特征和血气情况接受碳酸氢盐、乙醇治疗。已知摄入甲醇且伴有高阴离子间隙代谢性酸中毒或终末器官损伤证据的患者，无论甲醇水平如何，均接受血液透析。血液透析处方包括使用大表面积透析器（≥1.5平方米），血流速度为250 - 350毫升/分钟，透析液流速为500毫升/分钟，持续4 - 6小时。2009年7月9日至11日，91名平均年龄为40±8.5岁的男性接受了血液透析，13名患者需要进行第二次血液透析。患者饮用了100 - 500毫升非法酒类，症状在6至60小时后出现。临床特征包括胃肠道症状（83.5%）、视觉障碍（60.4%）、中枢神经系统症状（59.3%）和呼吸困难（43.9%）。血液透析前，平均pH值为7.11±0.04（范围6.70 - 7.33），平均碳酸氢盐水平为8.5±4.9毫摩尔/升（范围2 - 18）。3例患者死于甲醇中毒。死亡率与严重代谢性酸中毒（pH≤6.90）、需要呼吸机支持以及入院时昏迷/癫痫发作相关（P < 0.001）。及时进行血液透析、使用碳酸氢盐、乙醇和支持性治疗在甲醇中毒时可挽救生命。
