A Case Series of Critical Methanol Poisoning
Keywords:
Methanol poisoning, Neurologic manifestation, Visual manifestationAbstract
Methanol poisoning commonly causes severe neurological and visual symptoms can be fatal. This study aimed to describe the assessment of severe neurological and visual symptoms in patients with methanol poisoning resulting from the ingestion of traditional herbal liquor. A total of 25 patients who consumed herbal liquor and presented to the emergency department were studied. Among them, 7 patients exhibited severe neurological symptoms and visual disturbances. Most of the affected individuals were male and of working age. Abnormal findings were observed in 5 patients from brain computed tomography (CT) scans, all showing bilateral putamina necrosis. In addition, diffuse cerebral edema and bilateral occipital necrosis were also noted. Visual and ophthalmic evaluations revealed abnormalities in 3 patients. Retinal abnormalities were detected, with some improvement upon follow-up. However, reduced visual acuity was found in others, and optical coherence tomography (OCT) showed retinal nerve fiber layer (RNFL) thinning by 50-70%. Methanol poisoning from traditional herbal liquor, especially when patients present late to the hospital, can result in severe neurological symptoms and death. For survivors with permanent impairments, a referral for a return-to-work evaluation and work modification, based on their health status, is recommended.
References
Eskandrani R, Almulhim K, Altamimi A, Alhaj A, Alnasser S, Alawi L, et al. Methanol poisoning outbreak in Saudi Arabia: a case series. J Med Case Rep 2022;16(1):357.
Shafi H, Imran M, Usman HF, Sarwar M, Tahir MA. Eight fatalities due to drinking methanol-tainted alcohol in Pakistan: a case report. Egypt J Forensic Sci 2016;6(4):515-9.
Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American academy of clinical toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol 2002;40(4):415-46.
Abubakar M, Arif MM, Kausar H, Khan SH, Nisar W, Shahzad K. Methanol formation, toxicity and its impact on the human nervous system and liver. PJHS-Lahore 2022;4(10):12-20.
Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F, Banimostafavi ES, Sharifpour A, et al. Methanol poisoning as a new world challenge: A review. Ann Med Surg (Lond) 2021;66:102445.
Kaewput W, Thongprayoon C, Petnak T, Chewcharat A, Boonpheng B, Bathini T, et al. Inpatient burden and mortality of methanol intoxication in the United States. Am J Med Sci 2021;361(1):69-74.
Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P, et al. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol (Phila) 2014;52(10):1013-24.
Dejburum P, Setapura P, Sansilapin C, Chantian T. A study of methanol poisoning outbreak from pickled liquor in three communities, Chonburi, Thailand. SEE Conf Abstr 2023;1.
Karnjanasin N, Phanthangkun P. Yadong - Thai herbal liquor. Kalasin Uni. J. Humanit. Soc. Sci. Innov 2022;1(1):75-81.
Eweda SA, Hasb Elnabi MA. Mortality prediction in acute methanol intoxication: role of poison severity score and sequential organ failure assessment score. Egyptian Society of Clinical Toxicology Journal 2023;11(2):100-13.
Sanaei-Zadeh H, Esfeh SK, Zamani N, Jamshidi F, Shadnia S. Hyperglycemia is a strong prognostic factor of lethality in methanol poisoning. J Med Toxicol 2011;7(3):189-94.
Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes -- a multicenter study. Clin Toxicol (Phila) 2012;50(9):823-31.
Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank's Toxicologic Emergencies, 11th ed. New York: McGraw-Hill Education; 2019.
Liberski S, Kaluzny BJ, Kocięcki J. Methanol-induced optic neuropathy: a still-present problem. Arch Toxicol 2022;96(2):431-451.
Hovda KE, McMartin K, Jacobsen D. Methanol and Formaldehyde. In: Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. New York: Springer; 2017. p. 1769-86.
Praharaj SK, Munoli RN, Shenoy S, Udupa ST, Thomas LS. High-dose thiamine strategy in Wernicke-Korsakoff syndrome and related thiamine deficiency conditions associated with alcohol use disorder. Indian J Psychiatry 2021;63(2):121-6.
Zakharov S, Kotikova K, Nurieva O, Hlusicka J, Kacer P, Urban P, et al. Leukotriene-mediated neuroinflammation, toxic brain damage, and neurodegeneration in acute methanol poisoning. Clin Toxicol (Phila) 2017;55(4):249-59.
Taheri MS, Moghaddam HH, Moharamzad Y, Dadgari S, Nahvi V. The value of brain CT findings in acute methanol toxicity. Eur J Radiol 2010;73(2):211-4.
Eells JT. Methanol-induced visual toxicity in the rat. J Pharmacol Exp Ther 1991;257(1):56-63.
Sharpe JA, Hostovsky M, Bilbao JM, Rewcastle NB. Methanol optic neuropathy: a histopathological study. Neurology 1982;32(10):1093-100.
Mousavi-Roknabadi RS, Alibeigi M, Sharifi M, Mousavi-Roknabadi RS, Beizavi Z. Visual disturbances in patients with acute methanol poisoning: a cross-sectional study. Int J Med Toxicol Forensic Med 2021;11(1):1-8.
Dejburum P, Sansinlapin C, Chantian T. A study of methanol poisoning outbreak from infused liquor in three communities, Chonburi, Thailand. MKHJ 2024;21(3):151-63.
Rym M, Wijden N, Hela M, Hela S, Nozha B, Cheour M. Ocular manifestations after acute methanol poisoning. Neuroophthalmology 2023;47(4):193-8.
Sanaei-Zadeh H. Typical bilateral putaminal lesions of methanol intoxication. J Emerg Med 2012; 42(2): 178-9.
Hsu HH, Chen CY, Chen FH, Lee CC, Chou TY, Zimmerman RA. Optic atrophy and cerebral infarction causesd by methanol intoxication: MRI. Neuroradilolgy 1997;39(3):192-4.
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