Title: Acute Methyl Alcohol Poisoning: A Case Report in a Tertiary Hospital, Visakhapatnam

Authors: Dr Bethanapalli Mounika, Dr Y Gnana Sundara Raju M.D, Dr Tati Hyma

 DOI: https://dx.doi.org/10.18535/jmscr/v8i10.43

Abstract

Background: Methyl alcohol poisoning is an extremely hazardous poisoning commonly occurs via oral ingestion of illicit or adulterated liquors or as ethanol substitution. Toxicity results in gastrointestinal manifestations, metabolic acidosis, neurologic squeal, and even death. Early management with bicarbonate, ethanol and hemodialysis in patients having significant toxicity will decrease mortality and improves patient's outcome.

Materials and Methods: A case report of 15 patients admitted in King George Hospital, Visakhapatnam with history of intake of illicit liquor with progressive high anionic gap metabolic acidosis, altered sensorium and visual symptoms which improved with treatment with bicarbonate and hemodialysis.

Results: Out of 15 patients admitted, 12 patients had metabolic acidosis and treated with bicarbonate. Two patients improved with bicarbonate treatment and eight patients underwent hemodialysis for the improvement of symptoms. Two patients with hypotension and altered sensorium could not be recovered and expired.

Conclusion: Methanol exposure is an acute poisoning in which toxicity is due to metabolites like formate, which is the primary reason for acidosis. Diagnosis is based on suspicion of ingestion of illicit liquor, the presence of visual disturbances, metabolic acidosis with elevated anion and osmolar gaps. Treatment with bicarbonate and hemodialysis significantly improves the mortality and morbidity.

References

  1. Methyl Alcohol Poisoning: A Manifestation of Typical Toxicity and Outcome Laxmi Nand*, Subhash Chander**, Rajesh Kashyap***, Dalip Gupta****, https://www.japi.org/q2f464c4/
  2. ReynerLoza, Dimas Rodriguez, "A Case of Methanol Poisoning in a Child", Case Reports in Nephrology, vol. 2014, Article ID 652129, 3 pages, 2014. https://doi.org/10.1155/2014/652129
  3. Kumar, Manish et al. “Single center experience of managing methanol poisoning in the hilly state of Uttarakhand: A cross sectional study.” International journal of critical illness and injury science vol. 9,4 (2019): 172-176. doi:10.4103/IJCIIS.IJCIIS_49_19
  4. Najari F, Baradaran I, Najari D. Methanol Poisoning and Its Treatment. International Journal of Medical Toxicology and Forensic Medicine. 2020; 10(1): 26639. https://doi.org/10.32598/ijmtfm.v10i1.26639
  5. Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, Ritter H, et al. The methanol poisoning outbreaks in Libya 2013 and Kenya 2014. PLoS ONE. 2016;11:e0152676. [PMC free article] [PubMed] [Google Scholar]
  6. Jarwani BS, Motiani PD, Sachdev S. Study of various clinical and laboratory parameters among 178 patients affected by hooch tragedy in Ahmedabad, Gujarat (India): A single center experience. J Emerg Trauma Shock. 2013;6:73–7. [PMC free article] [PubMed] [Google Scholar
  7. Kute VB, Godara SM, Shah PR, Gumber MR, Goplani KR, Vanikar AV, et al. Hemodialysis for methylalcohol poisoning: A single-center experience. Saudi J Kidney Dis Transpl. 2012;23:37–43. [PubMed]
  8. Zyoud SH, Al-Jabi SW, Sweileh WM, Awang R, Waring WS. Bibliometric profile of the global scientific research on methanol poisoning (1902-2012). J Occup Med Toxicol. 2015;10:17. Published 2015 May 3. doi:10.1186/s12995-015-0062-
  9. Bennett, Ivan L. JR. M.D.; Cary, Freeman H. M.D.; Mitchell, George L. JR. M.D.; Cooper, Manuel N. M.D. Acute Methyl Alcohol Poisoning: A review based on Experiences in an outbreak of 323 Cases, Medicine: December 1953 - Volume 32 - Issue 4 - p 431-463.
  10. Acute methanol poisoning 'the blind drunk'. West J Med. 1981;135(2):122-128.
  11. Rietjens SJ, de Lange DW, Meulenbelt J. Ethylene glycol or methanol intoxication: which antidote should be used, fomepizole or ethanol? Neth J Med. 2014 Feb;72 (2):73-9. PMID: 24659589.      (google scholar)
  12. Ravichandran R R, Dudani R A, Almeida A F, Chawla K P, Acharya V N. Methyl alcohol poisoning. (Experience of an outbreak in Bombay). J Postgrad Med [serial online] 1984 [cited 2020 Oct 21]; 30:69-74. Available from: https://www.jpgmonline.com/text.asp?1984/30/2/69/546
  13. Trivedi TH, Yeolekar ME, Shejale SB, et al. Methanol poisoning in medical intensive care unit.  J Assoc  Physicians India 2001;49;257-258.
  14. Kumar P, Gogia A, Kakar A, Miglani P. An interesting case of characteristic methanol toxicity through inhalational exposure. J Family Med Prim Care. 2015;4(3):470-473. doi:10.4103/2249-4863.161359
  15. Gupta N, Sonambekar AA, Daksh SK, Tomar L. A rare presentation of methanol toxicity. Ann Indian AcadNeurol. 2013;16:249–51. [PMC free article] [PubMed] [Google Scholar].
  16. Blanco M, Casado R, Vázquez F, Pumara JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol. 2006;2013:452–4. [PubMed] [Google Scholar].

Corresponding Author

Dr Bethanapalli Mounika

Post Graduate, Department of General Medicine