Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Toxicol (Phila). 2019 Dec;57(12):1129-1136. doi: 10.1080/15563650.2019.1636992. Epub 2019 Jul 22.
Methanol poisoning is an important cause of mortality and morbidity worldwide. Although it often occurs as smaller sporadic events, epidemic outbreaks are not uncommon due to the illicit manufacture and sale of alcoholic beverages. We aimed to define methanol poisoning outbreak (MPO), outline an approach to triaging an MPO, and define criteria for prioritizing antidotes, extracorporeal elimination treatments (i.e., dialysis), and indications for transferring patients in the context of an MPO. We convened a group of experts from across the world to explore geographical, socio-cultural and clinical considerations in the management of an MPO. The experts answered specific open-ended questions based on themes aligned to the goals of this project. This project used a modified Delphi process. The discussion continued until there was condensation of themes. We defined MPO as a sudden increase in the number of cases of methanol poisoning during a short period of time above what is normally expected in the population in that specific geographic area. Prompt initiation of an antidote is necessary in MPOs. Scarce hemodialysis resources require triage to identify patients most likely to benefit from this treatment. The sickest patients should not be transferred unless the time for transfer is very short. Transporting extracorporeal treatment equipment and antidotes may be more efficient. We have developed consensus statements on the response to a methanol poisoning outbreak. These can be used in any country and will be most effective when they are discussed by health authorities and clinicians prior to an outbreak.
甲醇中毒是全球范围内导致死亡率和发病率的一个重要原因。尽管甲醇中毒通常以较小的零星事件发生，但由于非法制造和销售酒精饮料，也会不时出现爆发性流行。我们旨在定义甲醇中毒爆发（MPO），概述 MPO 的分诊方法，并定义解毒剂、体外清除治疗（即透析）的优先顺序标准，以及在 MPO 背景下转移患者的指征。我们召集了来自世界各地的一组专家，探讨 MPO 管理中的地理、社会文化和临床注意事项。专家根据与项目目标一致的主题回答了具体的开放式问题。本项目采用改良 Delphi 法。讨论继续进行，直到主题得到凝聚。我们将 MPO 定义为在特定地理区域内，短时间内发生的甲醇中毒病例数突然增加，超过了该特定人群中通常预期的水平。在 MPO 中，需要迅速开始使用解毒剂。稀缺的血液透析资源需要进行分诊，以确定最有可能从这种治疗中受益的患者。除非转移时间非常短，否则不应转移最严重的患者。运送体外治疗设备和解毒剂可能更有效。我们已经就甲醇中毒爆发的应对措施达成了共识声明。这些声明可在任何国家使用，并且在爆发前由卫生当局和临床医生进行讨论时将最为有效。
