Assessment and Initial Management of Methanol Poisoning Symptoms from Herbal Liquor in the Emergency Room
Keywords:
Assessment, Initial management, Methanolpoisoning, Herbal liquor, Emergency departmentAbstract
Background: Methanol poisoning is characterized by acute and severe clinical symptoms, leading to death or permanent blindness. Objective: To describe the clinical characteristics, laboratory findings, and initial emergency treatment of methanol poisoning. Methods: A descriptive study was conducted, collecting data on symptoms, signs, laboratory results, treatment, and patient management from medical records. Data were analyzed using descriptive statistics, presented as frequency, percentage, median, and interquartile range (IQR). Results: A total of 25 patients were studied, with 18 patients (72%) confirmed to have methanol poisoning, predominantly male. The median age was 43 years (IQR = 35-47 years, range 26-69 years). The majority (72%) exhibited severe clinical symptoms classified as grade 3. The median blood methanol level was 63.0 mg/dL (IQR = 24.4-48.0 mg/dL, range undetectable-580.0 mg/dL). Laboratory findings revealed the high anion gap metabolic acidosis and elevated osmolar gap. Emergency management included administration of ethanol, folinic acid, thiamine, and sodium bicarbonate (NaHCO3) to correct acidosis, along with hemodialysis and continuous renal replacement therapy (CRRT). Conclusion: Methanol poisoning presents acute and severe symptoms. Accurate initial clinical assessment and appropriate laboratory testing enable effective management to reduce mortality, complications, and disability.
References
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.
Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia S. Prognostic factors in methanol poisoning. Hum Exp Toxicol 2007;26(7):583-6.
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.
Kaewput W, Thongprayoon C, Petnak T, Bathini T, Vallabhajosyula S, Cheungpasitporn W. Inpatient burden and mortality of methanol intoxication in the United States. Clin Invest 2021;361(1):69-74.
Khanchanasin N, Phanthangkun P. Yadong - Thai herbal liquor. Kalasin Uni. J. Humanit. Soc. Sci. Innov 2022;1(1):75-81.
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.
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. Pak J Health Sci 2022;4(10):12-20.
Nekoukar Z, Zakariaei Z, Banimostafavi ES, Taghizadeh F, Sharifpour A, Musavi F, et al. Methanol poisoning as a new world challenge: a review. Ann Med Surg (Lond) 2021;66:102445.
Assanangkornchai S, Vichitkunakorn P, Saengow U, Wichaidit W, Talib M, Saingam D, et al. Facts and figures: alcohol in Thailand 2019-2021. Songkhla: Center for Alcohol Studies, Department of Epidemiology, Faculty of Medicine, Prince of Songkla University; 2022.
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):286-94.
Brent J. Methanol poisoning and the role of fomepizole. In: Afshari R, Monzavi SM, editors. Afshari's Clinical Toxicology and Poisoning Emergency Care. 2nd ed. Mashhad: Mashhad Univ Med Sci; 2012. p. 364-9.
lamsirikij C, Piromruen P, Chernbumrung T, Wananukul W. Lessons learned in toxicology from the patient: methanol intoxication. Thai J Toxicol 2014;29(1-2):81-8.
Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med 2004;30(9):1842-6.
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. 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.
Decker EM, Briski DN, Salem A, Noor E, Khashan A. Methanol intoxication-associated brain hemorrhages: can early detection be life-saving? A case report. Am J Case Rep 2023;24:e938749.
Alqurashi LG, Alqurashi SF, Khalid MK, Falemban HA, Alhind ZY, Alsanosi MS, et al. Case reports study on methanol poisoning in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. J Clin Med 2023;12(13):1-11.
Ashurst VJ, Nappe MT. Methanol toxicity. StatPearls [Internet]. 2025 [cited 2024 Sep 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482121/
Ramathibodi Hospital, Mahidol University. Ramathibodi Poison Center [Internet]. Bangkok: Ramathibodi Hospital; 2024 [cited 2024 Sep 5]. Available from: https://www.rama.mahidol.ac.th/poisoncenter/th/ pois-cov/Methanol
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(357):1-7.
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