Tuesday, March 18, 2014

Dialysis for toxic alcohols, new empiric data

Why I love twitter.

Immediate download.

See if you can get a few more authors next time.
Interesting introduction in the article about the disparity betweeen cases and resources for treating methanol. Most resources  are available in the developed world (dialysis, fomepizole) but most cases occur in the developing world. Also interesting note was that some Islamic Countries have social bans on the medicinal use of alcohol. That could make treatment pretty dicey.

They prospectively observed 24 cases of methanol ingestion out of 121 cases in a mass methanol poisoning in the Czech Republic. Looks like it was due to contamination of spirits with industrial methanol. Apparently this is a relatively common problem.

41 deaths. All patients in the observation cohort were treated with ethanol (17 patients) or fomepizole (4) or both (3) to prevent conversion of methanol to the downstream toxic metabolite, formic acid.
15 years old and this page still stands-up. Some stuff never changes.
Page 358 of the Fluids Book.
The authors present clearance data on 11 patients treated with conventional dialysis and 13 treated with continuous dialysis.

The half life of methanol with conventional dialysis was 3.7 hours and 8.1 hours with continuous dialysis. Not suprisingly all of the componants associated with more efficient dialysis were associated with with faster clearance of methanol: increased dialyzer surface area, increased blood flow and increased dialysate flow. Those half-lifes are remarkably shorter than the half life of methanol in the body using renal and pulmonary clearance.

On the other hand folate supplementation, the pre-dialysis methanol level and the nature of the antidote (ethanol versus fomepazole) made no difference.

The shorter half-life with intermittent conventional dialysis did not transplant into better patient survival.

They turned their math into specific treatment guidelines.

Some interesting tidbits. You know that graft that shows that the osmolar gap falls as the anion gap rises?
Canadian Family Physician
That wasn't the case so much here, they found simultaneous high anion and osmolar gaps.

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