Hemodialysis for methanol intoxication

We describe nine patients with methyl alcohol poisoning who were treated with hemodialysis. The time from ingestion to dialysis varied from 4 to 100 hours. Predialysis blood methanol levels ranged from 3 to 570 mg/dl. All patients were acidotic and had an increased anion gap. Two patients died, seven recovered, but three had permanent visual impairment. There was little correlation between the blood methanol level or anion gap and visual outcome. The interval from ingestion to treatment appears to be more important than the initial biochemical status. We recommend prompt hemodialysis if the blood methanol level is above 50 mg/dl, when an amount of methanol exceeding the minimal lethal dose (30 ml) is known to have been ingested, when there is evidence of acidosis or when an abnormality has developed in vision, funduscopic examination or mental state. Concurrent therapy with alkali and ethanol is vital.     

Is it long-term continuous drinking or the post-drinking withdrawal period that triggers the first acute alcoholic pancreatitis?

OBJECTIVE: Unlike patients with alcoholic hepatitis, patients with acute alcoholic pancreatitis seldom come into the hospital in an intoxicated state. Long-term history of heavy drinking induces increases in the serum pancreatic enzymes and pancreatitis-associated protein profiles during the withdrawal period. The aim of this study was to investigate the role of withdrawal in triggering acute alcoholic pancreatitis by studying the time-course of development of the first symptoms of the first acute alcoholic pancreatitis. MATERIAL AND METHODS: One hundred patients (85 M, 15 F, mean age 46, range 18-73 years) with the first acute alcoholic pancreatitis were asked three different questions in an attempt to clarify the same issue: Had you already stopped continuous drinking before the start of the acute abdominal pain that later led to hospitalization? Had you already stopped continuous drinking before you started to experience nausea or vomiting? How many hours after taking the last drop of alcohol did you start to feel pain (0 h, 1<6 h, 7-12 h, 13-24 h, 25-48 h, >48 h)? The amount of alcohol consumed was evaluated 1) during the past week and 2) during the past 2 months. The severity of the pancreatitis was assessed by serum C-reactive protein concentration, presence of necrosis, the development of pancreatic complications and the length of stay in hospital and in the intensive care unit. RESULTS: Eighty-five patients were able to respond to the questions. Of these, 69% had developed pain and 91% nausea/vomiting only after they had already stopped continuous drinking. Whereas 29% of the patients developed some symptoms before stopping drinking, the majority of the patients developed symptoms during the first day after cessation (43%) or later (28%), mainly during the second day of cessation of drinking. In both the univariate analysis and the multivariate analysis the timing of the symptoms was dependent on the amount of alcohol consumed during the previous 2 months and in the past week. CONCLUSIONS: In the majority of patients with first acute alcoholic pancreatitis, the symptoms begin during the early withdrawal period. The withdrawal period might be more important than previously emphasized in the development of acute alcoholic pancreatitis.     

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales,Australia

Aims To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. Design Telephone‐based cross‐sectional survey. Setting New South Wales, Australia. Participants A total of 1090 people aged 18–39 years old. Findings Seventy‐five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol‐related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51–58%) of both males and females who had consumed at acute‐risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51–61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15–23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7–15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48–61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the ‘non‐intoxicated’ patrons reporting that they had seen licensed premises staff intervene in some way with other ‘intoxicated’ patrons. Conclusions While the majority of 18–39‐year‐olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.     

Prolonged acute renal failure and severe polyradiculopathy in ethylene glycol intoxication

Ethylene glycol intoxication involves acute renal failure and severe metabolic acidosis. Prolonged renal insufficiency can occur but terminal chronic renal failure has been reported in very few cases. We describe a patient who after ingestion of 920 ml of ethylene glycol developed prolonged acute renal failure needing hemodialysis for 37 days and then he partly recovered renal function. The patient developed a severe sensitive-motor and autonomic polyradiculopathy.     

L'intoxication alcoolique aiguë de l'adulte est-elle,en France,une urgence métabolique ?

Some biological data of 63 acute alcoholic poisoning (without drug ingestion) in adults were studied during a brief hospitalization. Mean arterial blood concentration of lactate was 2,34 mmol/l +/- 0,13, of ethanol was 53 +/- 3,68 mmol/l. No correlation was found between these two variables and we have not registered lactic acidosis. Arterial blood acid base balance was normal for 24 of 38 unconscious patients. The results of other fourteen showed moderate acidosis, either mixed or respiratory either metabolic, without hypoglycemia or ketonuria. No correlation between arterial blood ions H+ concentration (44,72 +/- 1,18 nmol/l (m +/- sem) and concomitant arterial blood ethanol concentration was found. Moreover, no correlation between 46 blood glucose concentrations (without prior glucose perfusion) and alcoholemia was found. Only two 18 hours fasting chronic alcoholics showed hypoglycemia. These results confirm that acute ethanol intoxication is a potential respiratory emergency in adults, and not a metabolic one (this last pattern being true for children). No confusion between acute intoxication and alcoholic ketoacidosis, alcohol induced fasting hypoglycemia or shoshin beriberi must be made.     

Acute Self-Induced Poisoning With Sodium Ferrocyanide and Methanol Treated With Plasmapheresis and Continuous Renal Replacement Therapy Successfully: A Case Report

Self-induced poisoning with chemicals is one of the most commonly used suicide methods. Suicide attempts using massive pure sodium ferrocyanide and methanol are rare. This article discusses the management of acute intentional self-poisoning using sodium ferrocyanide and methanol.We present a case of acute self-induced poisoning using sodium ferrocyanide and methanol admitted to our hospital 2 hours after ingestion. He was deeply unconscious and unresponsive to painful stimuli. The laboratory findings showed acute kidney injury and severe metabolic acidosis. We took effective measures including endotracheal intubation and mechanical ventilation to ensure the vital signs were stable. Subsequently, we treated the patient using gastric lavage, bicarbonate, ethanol, plasmapheresis (plasma exchange), and continuous renal replacement therapy (CRRT) successfully. He gradually recovered from poisoning and was discharged without abnormalities on the 6th day. Follow-up for 3 months revealed no sequelae.Blood purification including plasmapheresis and CRRT is an effective method to scavenge toxicants from the body for acute self-poisoning with sodium ferrocyanide and methanol. Treatment strategies in the management of poisoning, multiple factors including the removal efficiency of toxin, the protection of vital organs, and the maintenance of homeostasis must be considered.     

Hyperamylasemia following methyl alcohol intoxication. Source and significance

Methyl alcohol intoxication has been reported to cause hyperamylasemia and pancreatitis. We describe a patient with severe, nonfatal methyl alcohol intoxication who had a rise in serum amylase activity with the level peaked on the second hospital day at tenfold the upper limit of normal. However, isoamylase analysis showed that this striking hyperamylasemia was due to salivary-type amylase. Furthermore, the serum lipase activity remained entirely normal during the peak amylase elevation. Thus, in cases of methyl alcohol intoxication, as in other clinical situations, hyperamylasemia, even when striking, should not be equated with pancreatitis. More specific laboratory tests for pancreatitis should be used before embarking on extensive investigations of the pancreas.     

Yam bean seed poisoning mimicking cyanide intoxication

Background: Yam bean is a common food in southern Taiwan. However, its seeds are rarely consumed. We describe five patients of yam bean seed poisoning in Taiwan, one of them life‐threatening. Clinical presentation: The five patients presented with perioral numbness, nausea and vomiting after eating a same soup made from yam bean seeds. One of them, a 54‐year‐old woman, had difficulty breathing and lost consciousness. Physical examination showed dilated pupils and coma with no focal neurological signs. The initial blood pressure was normal. Laboratory data showed a severe anion gap metabolic acidosis, with a serum lactate level of 185 mg/dL. An initial diagnosis of cyanide intoxication was considered and she was given sodium nitrite and sodium thiosulfate i.v. Hypotension ensued shortly afterwards and pulmonary artery catheterization showed a decreased cardiac index. Aggressive fluid and inotropic therapy were given and the patient eventually recovered. The other four patients suffered only minor gastrointestinal and neurological symptoms and received supportive treatment. Cyanide levels were negative in all five patients. Conclusion: Yam bean seed poisoning can cause acute metabolic acidosis and altered mental status, which could be confused with acute cyanide intoxication from a cyanogenic glycoside‐containing plant. To our knowledge, this is the first outbreak of yam bean seed poisoning reported in the English published work.     

Symptomatic hyponatremia after voluntary excessive water ingestion in a patient without psychiatric problems

Water intoxication usually happens in patients with a psychiatric problem, who are subject to compulsive water ingestion, and during clinical examinations, such as uroflowmetry, and is seldom observed in ordinary people. Here we report a patient with severe hyponatremia due to voluntary water drinking coexisting with no psychiatric problems. The case presented clinically significant hyponatremia 124 mmol/L without any signs of dehydration after voluntary ingestion of 4000 ml of water over 3 hours. She normally responded to ingestion of 1000 ml of water over 20 min after recovery from hyponatremia, and did not meet the diagnostic criteria of SIADH. She was not a compulsive drinker. The present case suggests that one should consider water intoxication as a cause of hyponatremia in a patient without signs of dehydration, even if he/she does not have a history of compulsive water ingestion.     

Methanol intoxication: differential diagnosis from anion gap-increased acidosis

We report a case of methanol intoxication, which was not distinguished from ethylene glycol intoxication during treatment. A 65-year-old man was transferred to our emergency department because of drowsiness and remarkable metabolic acidosis. He was intubated because his consciousness disturbance worsened. The diagnosis was suspected as methanol or ethylene glycol intoxication in addition to ethanol intoxication. Administration of ethanol and hemodialysis were chosen for his essential treatments. When he was extubated, he complained about visual loss. His brain computed tomography scans revealed putaminal lesions, which are rarely reported in methanol intoxication. Diagnosis of methanol intoxication was confirmed by the serum high methanol levels.     

Organic acids in ethylene glycol intoxication

Ethylene glycol intoxication produces a severe metabolic acidosis with an increased anion gap. We examined three patients with this intoxication to identify the organic acids that cause acidemia in humans and to determine how effectively these acids can be removed during dialysis. All patients had markedly elevated glycolic acid levels of more than 7 meq/L and two patients had lactic acidosis, with lactic acid levels of greater than 5.0 meq/L. Hemodialysis clearance of glycolic acid was 105 mL/min, and 159 meq was removed in 3 hours. After hemodialysis using a bicarbonate dialysate, the mean anion gap decreased from 34 to 23 meq/L; the mean serum bicarbonate concentration increased from 5.5 to 20 meq/L. Therefore, glycolic and lactic acids are important in the acidosis caused by ethylene glycol intoxication in humans. Hemodialysis treatment with a bicarbonate dialysate is an efficient method for removing glycolic acid and resolving acidemia.     

急性胰腺炎的电解质酸碱失衡及TPN治疗

本文报道25例急性出血坏死性胰腺炎（ANP），30例急性水肿性胰腺炎（AEP）的电解质与酸碱失调分析结果，以ANP表现显著，有低钾，低钠，低氯，低钙，低磷，代酸与代酸呼碱，低氧血症，低蛋白血症的表现,与AEP比较有显著性差异（P＜0．01）。16例ANP型采用全肠外营养（TPN）治疗，其中13例存活，与过去未用TPN治疗22例，14例死亡有显著差异（P＜0．01）。作者认为TPN协同治疗ANP患者，对于提供营养，抑胰分泌，促进胰腺组织修复，纠正水盐代谢紊乱，防止并发症与提高存活率有重要意义。对TPN的用法及热原供给作了简要讨论。     

Metabolic acidosis in severe acute asthma. Effect of alkaline therapy]

Respiratory acidosis of severe acute asthma is a severity factor. In this paper the treatment of associated metabolic acidosis is discussed. Among 34 consecutive episodes of severe acute asthma with acidosis (pH < 7.35) treated with continuous adrenaline perfusion, theophylline and hydrocortisone hemisuccinate, respiratory acidosis was observed in 12, metabolic acidosis in 2 and mixed respiratory and metabolic acidosis in 20. The association of hypercapnic acidosis with hypochloraemic acidosis reflected a time of installation longer than when respiratory acidosis only was present (p < 0.05). Among the 22 patients who had metabolic acidosis on admission, 14 were treated with 168 +/- 82 mmol of sodium bicarbonate, the remaining 8 patients being untreated and acting as controls. The rapidity with which pH was corrected was the same in the treated and untreated groups (9.1 +/- 5.5 hours vs 6.7 +/- 3.7 hours), whereas dyspnoea (respiratory rate < 18/min) was more rapidly corrected in the treated group that in controls (11.6 +/- 5.7 hours vs 5.9 +/- 5.9 hours; p < 0.05). It is concluded that in more than 50% of the cases respiratory acidosis of severe acute asthma is associated with a metabolic acidosis. Correcting this metabolic acidosis with sodium bicarbonate results in improvement of respiration, perhaps by facilitating the action of bronchodilator catecholamines.     

Inpatient Burden and Mortality of Methanol Intoxication in the United States

BackgroundThis study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for methanol intoxication in the United States.Materials and MethodsA total of 603 hospitalized patients with a primary diagnosis of methanol intoxication from 2003 to 2014 were identified in the National Inpatient Sample database. The inpatient prevalence, clinical characteristics, treatments, outcomes, resource utilization, were investigated. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality.ResultsThe overall inpatient prevalence of methanol intoxication among hospitalized patients was 6.4 cases per 1,000,000 admissions in the United States. The mean age was 38±18 (range 0–86) years. 44% used methanol for suicidal attempts. 20% of admissions required mechanical ventilation, and 40% required renal replacement therapy. The three most common complications were metabolic acidosis (44%), hypokalemia (18%), and visual impairment or optic neuritis (8%). The three most common end-organ failures were renal failure (22%), respiratory failure (21%), and neurological failure (17%). 6.5% died in the hospital. Factors associated with increased in-hospital mortality included alcohol drinking, hypernatremia, renal failure, respiratory failure, circulatory failure, and neurological failure. The mean length of hospital stay was 4.0 days. The mean hospitalization cost per patient was $43,222ConclusionThe inpatient prevalence of methanol intoxication in the United States was 6.4 cases per 1,000,000 admissions. The risk of in-hospital mortality mainly depended on the number of end-organ failures.     

Drinking context and other influences on the drinking of 15-year-old New Zealanders

This study investigated the influence of the situational characteristics of the drinking setting and a number of parental, personal and demographic variables on adolescents’alcohol use. The sample were 15-year-old participants in a multidisciplinary longitudinal study carried out in New Zealand. Measures of alcohol consumption were self reported amount of alcohol consumed on the most recent drinking occasion and amount usually consumed. All of the situational variables investigated had an effect on the amount of alcohol consumed on the most recent occasion. Greater amounts of alcohol were consumed if the alcohol was obtained from peers or by the 15-year-olds themselves, if the drink was consumed away from their own home, in the presence of peers only, and during the evening. More money to spend each week and lower SES were also associated with reports of greater alcohol consumption on the most recent drinking occasion. Adolescents with female friends who approved of drinking reported greater amounts of alcohol, the effect of female friends was most marked in the lower amounts reported by males who had female friends that disapproved of drinking. For amount of alcohol usually consumed, reports of larger amounts of alcohol were associated with more money available to spend each week and with lower SES. Furthermore, both males and females reported greater usual amounts if their male friends approved of drinking; female friends’approval was associated with greater amounts of alcohol usually being consumed, this effect was strongest for males. Sixty-eight per cent of the 15-year-olds indicated that they thought they definitely or probably would get drunk in the future.     

Effects of energy drink ingestion on alcohol intoxication

BACKGROUND: Well-known reports suggest that the use of energy drinks might reduce the intensity of the depressant effects of alcohol. However, there is little scientific evidence to support this hypothesis. OBJECTIVE AND METHODS: The present study aimed at evaluating the effects of the simultaneous ingestion of an alcohol (vodka(37.5%v/v)) and an energy drink (Red Bull-3.57 mL/kg), compared with those presented after the ingestion of an alcohol or an energy drink alone. Twenty-six young healthy volunteers were randomly assigned to 2 groups that received 0.6 or 1.0 g/kg alcohol, respectively. They all completed 3 experimental sessions in random order, 7 days apart: alcohol alone, energy drink alone, or alcohol plus energy drink. We evaluated the volunteers' breath alcohol concentration, subjective sensations of intoxication, objective effects on their motor coordination, and visual reaction time. RESULTS: When compared with the ingestion of alcohol alone, the ingestion of alcohol plus energy drink significantly reduced subjects' perception of headache, weakness, dry mouth, and impairment of motor coordination. However, the ingestion of the energy drink did not significantly reduce the deficits caused by alcohol on objective motor coordination and visual reaction time. The ingestion of the energy drink did not alter the breath alcohol concentration in either group. CONCLUSIONS: Even though the subjective perceptions of some symptoms of alcohol intoxication were less intense after the combined ingestion of the alcohol plus energy drink, these effects were not detected in objective measures of motor coordination and visual reaction time, as well as on the breath alcohol concentration.     

Activation of brain NOP receptors attenuates acute and protracted alcohol withdrawal symptoms in the rat

Background: Alcohol withdrawal refers to a cluster of symptoms that may occur from suddenly ceasing the use of alcohol after chronic or prolonged ingestion. These symptoms make alcohol abstinence difficult and increase the risk of relapse in recovering alcoholics. In previous studies, we demonstrated that treatment with Nociceptin/orphanin FQ (N/OFQ) significantly reduces alcohol consumption and attenuates alcohol‐seeking behavior induced by environmental conditioning factors or by stress in rats. In this study, we evaluated whether activation of brain NOP receptors may also attenuate alcohol withdrawal signs in rats. Methods: For this purpose, animals were subjected to a 6‐day chronic alcohol intoxication (by intragastric administration), and at 8, 10, and 12 hours following cessation of alcohol exposure, they were treated intracerebroventricularly (ICV) with N/OFQ (0.0, 1.0, and 3.0 μg/rat). Somatic withdrawal signs were scored after ICV treatment. In a subsequent experiment, to evaluate N/OFQ effects on alcohol withdrawal‐induced anxiety, another group of rats was subjected to ethanol intoxication and after 1 week was tested for anxiety behavior in the elevated plus maze (EPM). In the last experiment, an additional group of rats was tested for anxiety elicited by acute ethanol intoxication (hangover anxiety). For this purpose, animals received an acute dose (3.0 g/kg) of 20% alcohol and 12 hour later were tested in the EPM following ICV N/OFQ (0.0, 1.0, and 2.0 μg/rat). Results: Results showed that N/OFQ significantly reduced the expression of somatic withdrawal signs and reversed anxiety‐like behaviors associated with both chronic and acute alcohol intoxication. N/OFQ did not affect anxiety scores in nondependent animals. Conclusions: These findings suggest that the N/OFQ‐NOP receptor system may represent a promising target for the development of new treatments to ameliorate alcohol withdrawal symptoms.     

Alcohol consumption in patients with acute or chronic pancreatitis.

Understanding of the relation between the alcoholic consumption and the development of pancreatitis should help in defining the alcoholic etiology of pancreatitis. Although the association between alcohol consumption and pancreatitis has been recognized for over 100 years, it remains still unclear why some alcoholics develop pancreatitis and some do not. Surprisingly little data are available about alcohol amounts, drinking patterns, type of alcohol consumed and other habits such as dietary habits or smoking in respect to pancreatitis preceding the attack of acute pancreatitis or the time of the diagnosis of chronic pancreatitis. This review summarizes the current knowledge. Epidemiological studies clearly show connection between the alcohol consumption in population and the development of acute and chronic pancreatitis. In the individual level the risk to develop either acute or chronic pancreatitis increases along with the alcohol consumption. Moreover, the risk for recurrent acute pancreatitis after the first acute pancreatitis episode seems also to be highly dependent on the level of alcohol consumption. Abstaining from alcohol may prohibit recurrent acute pancreatitis and reduce pain in chronic pancreatitis. Therefore, all the attempts to decrease alcohol consumption after acute pancreatitis and even after the diagnosis of chronic pancreatitis should be encouraged. Smoking seems to be a remarkable co-factor together with alcohol in the development of chronic pancreatitis, whereas no hard data are available for this association in acute pancreatitis. Setting the limits for accepting the alcohol as the etiology cannot currently be based on published data, but rather on the 'political' agreement.