Maryland Poison Center, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Wellstar Kennestone Hospital, Marietta, GA, USA.
Clin Toxicol (Phila). 2024 Feb;62(2):120-125. doi: 10.1080/15563650.2024.2319863. Epub 2024 Mar 11.
The diagnosis of toxic alcohol poisoning is often based on clinical presentation and nonspecific surrogate laboratory studies due to limited testing availability. Fomepizole is the recommended antidote and often administered empirically. The objective of this study is to identify substances that mimic toxic alcohols and compare key clinical factors between toxic alcohol and non-toxic alcohol exposures when fomepizole was administered.
This study was a retrospective evaluation using the National Poison Data System from January 1, 2010 through December 31, 2021. Exposures were included if fomepizole was administered. Toxic alcohol exposures had ethylene glycol or methanol as a coded substance. For exposures not coded as a toxic alcohol, the first substance was described. Paracetamol (acetaminophen) exposures from 2020 and 2021 were excluded.
Fomepizole was reportedly used 25,110 times over 12 years. Use increased from 1,955 in 2010 to 2,710 in 2021. Most administrations were for reported toxic alcohol poisoning (60 percent) but use in reported non-toxic alcohol poisoning was greater starting in 2020. Toxic alcohol exposures were older (43.3 versus 39.8 years; < 0.001) and more likely male (65.7 percent versus 58.2 percent). Level of care was mostly a critical care unit (67.7 percent), which was less common in toxic alcohol (63.3 percent) than non-toxic alcohol exposures (74.2 percent). The most common non-toxic alcohol substances were ethanol (24.9 percent) or an unknown drug (17.5 percent). Acidosis, increased creatinine concentration, anion gap, and osmolal gap, and kidney failure were coded in a lower proportion of toxic alcohol exposures than non-toxic alcohol exposures ( < 0.001).
The inability to provide rapid clinical confirmation of toxic alcohol poisoning results in the empiric administration of fomepizole to many patients who will ultimately have other diagnoses. Although fomepizole is relative well tolerated we estimated that this practice costs between $1.5 to $2.5 million. The major limitations of this work include the biases associated with retrospective record review, and the inability to confirm the exposures which may have resulted in allocation error.
Most fomepizole use was for a presumed toxic alcohol. This recently shifted to greater use in likely non-toxic alcohol poisoning. Key difference between the groups suggest fomepizole administration was likely due to the difficulty in diagnosis of toxic alcohol poisoning along with the efficacy and safety of fomepizole. Increased toxic alcohol laboratory testing availability could improve timely diagnosis, reserving fomepizole use for toxic alcohol poisoning.
由于检测手段有限，有毒醇类中毒的诊断通常基于临床表现和非特异性替代实验室研究。非那西汀是推荐的解毒剂，通常是经验性使用。本研究的目的是确定模仿有毒醇类的物质，并比较在使用非那西汀时有毒醇类和非有毒醇类暴露的关键临床因素。
本研究是对 2010 年 1 月 1 日至 2021 年 12 月 31 日期间国家毒物数据系统的回顾性评估。如果使用了非那西汀，则包括暴露。有毒醇类暴露的编码物质为乙二醇或甲醇。对于未编码为有毒醇类的暴露，首先描述了第一种物质。2020 年和 2021 年的扑热息痛（对乙酰氨基酚）暴露被排除在外。
在 12 年中，非那西汀据报道使用了 25110 次。使用量从 2010 年的 1955 次增加到 2021 年的 2710 次。大多数使用是针对报告的有毒醇类中毒（60%），但从 2020 年开始，在报告的非有毒醇类中毒中使用量更大。有毒醇类暴露者年龄更大（43.3 岁 vs. 39.8 岁；<0.001），更可能是男性（65.7% vs. 58.2%）。治疗水平主要是重症监护病房（67.7%），在有毒醇类（63.3%）中比非有毒醇类（74.2%）中更为常见。最常见的非有毒醇类物质是乙醇（24.9%）或未知药物（17.5%）。酸中毒、肌酐浓度升高、阴离子间隙和渗透压间隙以及肾衰竭在有毒醇类暴露中编码的比例低于非有毒醇类暴露（<0.001）。
由于无法快速临床确认有毒醇类中毒，导致许多最终将有其他诊断的患者经验性使用非那西汀。尽管非那西汀相对耐受良好，但我们估计这种做法的成本在 150 万至 250 万美元之间。这项工作的主要限制包括回顾性记录审查相关的偏见，以及无法确认可能导致分配错误的暴露。
大多数非那西汀使用是为了治疗疑似有毒醇类中毒。最近，这种情况转变为在可能的非有毒醇类中毒中使用更多。两组之间的主要差异表明，非那西汀的使用可能是由于有毒醇类中毒的诊断困难，以及非那西汀的疗效和安全性。增加有毒醇类实验室检测的可用性可以改善及时诊断，将非那西汀的使用保留给有毒醇类中毒。
