Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Departments of Critical Care Medicine and Clinical Neurosciences, McCaig Tower, Foothills Medical Center, University of Calgary, 3134 Hospital Drive NW Calgary, Calgary, AB, T2N 2T9, Canada.
Neurocrit Care. 2024 Apr;40(2):734-742. doi: 10.1007/s12028-023-01821-2. Epub 2023 Sep 11.
Toxic alcohol poisoning is regularly encountered in emergency departments and intensive care units (ICUs). Most patients present with an altered level of consciousness, but the subsequent course and spectrum of neurologic complications and outcomes is highly variable.
We performed a population-based, multicenter retrospective cohort study of critically ill patients with toxic alcohol poisoning admitted to ICUs in Alberta, Canada, between 2007 and 2019 to describe neurologic sequelae, including seizures, coma, neuroimaging abnormalities, persistent cognitive or visual impairment, and mortality. Multivariate analysis was performed to identify predictors of poor outcome.
We identified 104 patients, including 55 (53%) with methanol ingestion, 36 (35%) with ethylene glycol ingestion, and 13 (13%) with isopropanol ingestion. In patients who underwent neuroimaging, abnormalities were detected in 9 of 24 (38%) with methanol toxicity, 5 of 20 (25%) with ethylene glycol toxicity, and 0 of 10 with isopropanol toxicity (p = 0.07). Basal ganglia were commonly involved with both methanol and ethylene glycol poisoning, but prominent subcortical involvement and restricted diffusion were observed only with methanol poisoning. The composite of death, persistent cognitive impairment, or visual loss occurred in 13 (24%) patients with methanol poisoning, compared with one (3%) with ethylene glycol poisoning and none with isopropanol poisoning (p = 0.006). Among patients with methanol toxicity, greater elevation of the anion gap and lower Glasgow Coma Scale score were independent predictors of poor outcome. No patient with an anion gap ≥ 28 at presentation had a favorable recovery. Progression to death by neurologic criteria occurred in 3 of 55 (5%) patients with methanol poisoning and in none with other toxic alcohols.
Methanol overdose is the most common form of toxic alcohol poisoning to result in ICU admission. Poor neurologic outcomes may occur especially with methanol poisoning, with more than one in five patients dying or having persistent cognitive or visual impairment. A wide anion gap independently predicts poor outcome, emphasizing the importance of expeditious recognition and treatment.
在急诊科和重症监护病房（ICU）经常会遇到有毒性的酒精中毒。大多数患者表现为意识水平改变，但随后的神经系统并发症和结果的范围和谱是高度可变的。
我们对 2007 年至 2019 年期间在加拿大艾伯塔省 ICU 住院的有毒性酒精中毒的危重症患者进行了一项基于人群的多中心回顾性队列研究，以描述神经系统后遗症，包括癫痫发作、昏迷、神经影像学异常、持续性认知或视觉障碍和死亡率。进行了多变量分析以确定不良预后的预测因素。
我们确定了 104 名患者，其中 55 名（53%）摄入甲醇，36 名（35%）摄入乙二醇，13 名（13%）摄入异丙醇。在接受神经影像学检查的患者中，9 名（38%）甲醇毒性患者、5 名（25%）乙二醇毒性患者和 0 名（0%）异丙醇毒性患者存在异常（p=0.07）。基底节通常与甲醇和乙二醇中毒有关，但只有甲醇中毒才会出现明显的皮质下受累和弥散受限。13 名（24%）甲醇中毒患者死亡、持续性认知障碍或视力丧失的复合事件发生率高于 1 名（3%）乙二醇中毒患者和 0 名异丙醇中毒患者（p=0.006）。在甲醇毒性患者中，阴离子间隙升高和格拉斯哥昏迷评分降低是不良预后的独立预测因素。在就诊时阴离子间隙≥28 的患者中没有恢复良好的患者。根据神经学标准，3 名（5%）甲醇中毒患者进展为死亡，而其他有毒醇类患者则没有。
甲醇过量是导致 ICU 收治的最常见的毒性酒精中毒形式。不良神经结局可能尤其发生在甲醇中毒患者中，超过五分之一的患者死亡或存在持续性认知或视觉障碍。宽阴离子间隙独立预测不良预后，强调了快速识别和治疗的重要性。
