China
Africa
Explore chapters and articles related to this topic
Poisoning
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Haemodialysis or other extracorporeal techniques may be indicated to increase elimination of drugs (e.g. lithium, salicylates) or toxins (e.g. toxic alcohols) in patients with significant ingestions; the use of these techniques should always be discussed with a clinical toxicologist.
Alcohol-Induced Malabsorption in the Gastrointestinal Tract
Published in Victor R. Preedy, Ronald R. Watson, Alcohol and the Gastrointestinal Tract, 2017
Allan D. Thomson, Laura C. Heap, Roberta J. Ward
As the individual becomes more dependent on alcohol, malnutrition will increase, secondary to suppression of appetite and loss of social integration, and a preference to spend what little money is available on alcohol. The rate of evolution of this toxic alcohol malnutrition interaction will depend on a number of factors such as the individual susceptibility to damage to various organs. In addition, there will be a wide variation in alcohol intake, patterns of drinking, and the associated extent of poor nutrient intake in different patients. Some patients are thought to be particularly at risk of suffering brain damage due to thiamine deficiency and it is possible that extreme malabsorption in some drinking malnourished subjects may play a significant part in this deficiency. The consequence of such brain damage due to thiamine deficiency could be to interfere with further rehabilitation, to increase alcohol intake, and to cause the patient to deteriorate further. Reduced thiamine levels will increase alcohol intake directly and the development of folate deficiency will even more reduce the individual's ability to absorb thiamine.
Case 86: Unconscious Outside a Club
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
The patient has a history of using recreational drugs and was drinking alcohol prior to his presentation. The most striking result is the blood gas, which shows a profound metabolic acidosis and a raised anion gap. Potential causes of this include alcoholic ketoacidosis, ingestion of toxins (including toxic alcohols, such as ethylene glycol or methanol) or an overdose of aspirin (acetylsalicylic acid). There is no evidence that the patient has a lactic acidosis or diabetic ketoacidosis. The patient may be experiencing the sedative effects of GHB in addition to excess alcohol, possibly with other recreational drugs. He also has an apparent acute kidney injury, possibly due to rhabdomyolysis or induced by recreational drugs/other toxins.
Kidney outcomes after methanol and ethylene glycol poisoning: a systematic review and meta-analysis
Published in Clinical Toxicology, 2023
Carol Wang, Swapnil Hiremath, Lindsey Sikora, Salmaan Kanji, Ann Bugeja, Daniel Samaha, Manish M. Sood, Jennifer W. Y. Kong, Edward G. Clark
Toxic alcohols, including methanol, ethylene glycol, diethylene glycol, propylene glycol and isopropanol, are implicated in unintentional or intentional ingestions [1]. Although toxic alcohol poisonings are rare, with methanol ingestion resulting in 6.4 per 1,000,000 hospital admissions in the United States, they can be associated with significant morbidity and mortality [2,3]. This is partially attributable to challenges in establishing the diagnosis and often-delayed presentations to medical care [4]. Clinicians may refer to published guidelines for the management of methanol and ethylene glycol toxicities, but such guidelines have yet to be formulated for other types of toxic alcohols [5–7]. Management of such poisonings often involves the possible initiation of kidney replacement therapy [5,6,8]. In Canada, methanol and ethylene glycol made up 5.7 and 5.9%, respectively, of all poisonings treated with extracorporeal kidney replacement therapy between 2005 to 2014 [9]. Predictors of poor outcomes in methanol and ethylene glycol poisonings include severe acidosis with pH <7, coma and seizure at the time of clinical presentation [4,10–12]. Although toxic alcohols can be associated with concurrent acute kidney injury [13], and kidney replacement therapy is commonly used as a treatment for such patients, there is a paucity of literature focusing on kidney outcomes other than for ethylene glycol.
Fomepizole dosing during continuous renal replacement therapy – an observational study
Published in Clinical Toxicology, 2022
Yvonne E. Lao, Trond Vartdal, Sten Froeyshov, Brian Latimer, Christiane Kvaerner, Marija Mataric, Peter Holm, Siri Foreid, Dag Jacobsen, Kenneth McMartin, Knut Erik Hovda
Methanol and ethylene glycol are toxic alcohols with a potential fatal outcome when poisoned. Large outbreaks of methanol poisoning with high mortality are regularly reported [1,2], as are case reports of intentional or accidental ingestion of ethylene glycol [3,4]. Early treatment with the antidotes ethanol or fomepizole is effective and lifesaving [5]. Both substances act by inhibiting the alcohol dehydrogenase enzyme, and thus preventing the formation of the toxic metabolites (formic acid from methanol and glycolic acid from ethylene glycol). Although ethanol can cause a pronounced central nervous system (CNS) depression, it also requires frequent monitoring of plasma ethanol. Fomepizole, on the other hand, has limited side effects (e.g., headache and dizziness), and does not require monitoring of plasma concentration. Treatment guidelines therefore recommend fomepizole as the antidote of choice [5]. Plasma concentrations of fomepizole above 10 µmol/L are considered effective and will prevent formation of the toxic metabolites, based on studies done in non-human primates [6,7].
Analysis of fomepizole safety based on a 16-year post-marketing experience in France
Published in Clinical Toxicology, 2020
Riana Rasamison, Hélène Besson, Marie-Pierre Berleur, Azzurra Schicchi, Bruno Mégarbane
Toxic alcohol poisoning represents a concerning public health issue worldwide with the risk of elevated fatality rate and major sequelae. Based on the annual report of the American Association of Poison Control Centers’ National Poison Data System, about 7,000 ethylene glycol (EG) and 1,400 methanol exposures were reported in 2017 in the US, resulting in ∼190 severe and 26 fatal cases [1]. Although sporadic poisoning cases are relatively rare, accidental mass poisonings may cause hundreds of deaths, especially in the countries with limited accessibility to ethanol due to the use as ethanol substitute of homemade methanol-containing alcoholic beverages [2,3]. In the 2012 Czech Republic methanol poisoning outbreak, fatality rate was estimated to be ∼34% and based on examinations before hospital discharge and during follow-up, ∼40% of the patients were found to exhibit long-term neurological and visual sequelae with 8% of blindness [3,4].