Wu Xiaomei, Gu Meifeng, Wang Wei, Zhang Hainan, Tang Zhenchu
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Front Med (Lausanne). 2022 Jun 14;9:918812. doi: 10.3389/fmed.2022.918812. eCollection 2022.
Despite significant progress in treating methanol poisoning, the lack of training, hazard communication, and occupational safety protection education contributes to the risk of occupational exposure and methanol toxicity. In addition, early diagnosis and timely medical care are essential to reduce the risk of morbidity and mortality, yet it remains a challenging procedure.
A 35-year-old man working in a fireworks factory came to our emergency department with acute mental change and progressive disturbance of consciousness. The patient's vital signs were stable, and he presented with enlargement of both pupils with a weak reaction to light. Head computed tomography showed low signal intensities in the bilateral basal ganglia. He was admitted to the neurologic intensive care unit, where additional laboratory workup showed high anion-gap metabolic acidosis. Methanol poisoning was thus considered. Before being treated with sodium bicarbonate infusion, hemodialysis, folate, and high-dose vitamin B, the blood and urine samples were collected for toxicity tests, which turned out to be methanol poisoning. After 8 hours of hemodialysis, the patient's consciousness recovered, but he complained of a complete loss of vision in both eyes. Brain and optic nerve magnetic resonance images showed bilateral symmetric putamen lesions and optic neuropathy. Ophthalmic tests indicated visual pathway impairment and optic disc swelling but no fluorescein leakage. The right eye's vision was partially restored on the third day, but he could only count fingers at 20 cm. Unfortunately, his eyesight ceased to improve during the 6 months of follow-up.
Early diagnosis and prompt treatment will improve the prognosis of methanol poisoning in terms of vision and patient survival. Awareness and supervision of commercial alcohol use are indispensable for similar industrial processes.
尽管在治疗甲醇中毒方面取得了显著进展，但缺乏培训、危害告知以及职业安全防护教育增加了职业暴露和甲醇中毒的风险。此外，早期诊断和及时的医疗护理对于降低发病和死亡风险至关重要，但这仍然是一个具有挑战性的过程。
一名在烟花厂工作的35岁男性因急性精神改变和意识进行性障碍来到我们的急诊科。患者生命体征稳定，双侧瞳孔散大，对光反应微弱。头部计算机断层扫描显示双侧基底节区低信号强度。他被收入神经重症监护病房，进一步的实验室检查显示高阴离子间隙代谢性酸中毒。因此考虑为甲醇中毒。在接受碳酸氢钠输注、血液透析、叶酸和大剂量维生素B治疗之前，采集了血液和尿液样本进行毒性检测，结果证实为甲醇中毒。经过8小时的血液透析，患者意识恢复，但他抱怨双眼完全失明。脑部和视神经磁共振成像显示双侧对称性壳核病变和视神经病变。眼科检查表明视觉通路受损和视盘肿胀，但无荧光素渗漏。右眼视力在第三天部分恢复，但他只能在20厘米处数手指。不幸的是，在6个月的随访期间，他的视力没有进一步改善。
早期诊断和及时治疗将改善甲醇中毒患者的视力预后和生存情况。对于类似的工业过程，对商用酒精使用的认识和监管不可或缺。
