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METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ

Year 2021, Volume: 23 Issue: 3, 530 - 537, 31.12.2021

Ertan Cömertpay Oğuz Eroğlu Turgut Deniz

https://doi.org/10.24938/kutfd.956874

Abstract

Amaç: Metanol zehirlenmesi ülkemizde son zamanlarda sıkça karşılaşılan bir zehirlenme türüdür. Zehirlenme durumunda vakaların hızla tanınıp tedavi altına alınması sayesinde mortalite ve morbidite oranları azaltılabilir. Bu çalışmanın amacı, acil servise başvuran metanol zehirlenmesi hastalarının demografik özellikleri, fizik muayene bulguları ve laboratuvar sonuçları ile sağ kalım arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntemler: Hastalar metanol zehirlenmesi sonrası eksitus olanlar ve hayatta kalanlar olmak üzere 2 farklı gruba ayrıldı. Tüm hastaların demografik özellikleri, başvuru şikayetleri, fizik muayene bulguları ve laboratuvar sonuçları ve klinik sonlanımları kaydedildi. Grupların karşılaştırılmasında Chi-square, Student t-test ve Mann-Whitney U testi kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya metanol zehirlenmesi sonrası eksitus olan (n=5) ve hayatta kalanlar (n=12) olmak üzere toplam 17 hasta dahil edildi. Metanol zehirlenmesi sonrası en sık başvuru şikâyeti görme bozukluğu (%70.6) iken, bunu nefes darlığı (%35.3) ve bulantı-kusma (%35.3) takip ediyordu. Gruplar arasında başvuru şikâyeti bakımından farklılık saptanmadı. Her iki grupta da başta solunum sayısı (hiperventilasyon) olmak üzere vital bulguların ortalama değeri, normal değerinin üstündeydi. Ancak, vital bulgular bakımından gruplar arasında farklılık saptanmadı. Eksitus olan hasta grubundaki kreatinin düzeyi ve baz açığı seviyesi hayatta kalan gruptakilere göre anlamlı olarak artmışken, bikarbonat ve pH düzeyi ise anlamlı oranda azalmış olarak tespit edildi (sırasıyla p=0.015; 0.002, 0.020; 0.002).
Sonuç: Metanol zehirlenmesi sonrası ölen hastalarda, kreatinin değerindeki ve baz defisitindeki artış, derinleşen asidoz ve azalmış bikarbonat düzeyi kötü klinik sonlanımla uyumludur. Görme bozukluğuna eşlik eden hiperventilasyon ve bilinç kaybı durumlarında metanol zehirlenmesi akla gelmeli ve bir an önce uygun tedavi prosedürlerine başlanmalıdır.

Keywords

Formik asit Asit-Baz dengesi Sağ kalım Asidoz Metanol

References

  • 1. Satar S, Güneysel Ö, Türedi S, Yürümez Y, Akıcı A. Klinik Toksikoloji Tanı ve Tedavi. Alkoller ve Glikoller. Antalya. Çukurova Nobel Tıp Kitabevi, 2020.
  • 2. Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: Two outbreaks, a single center experience. Alcohol. 2020;88:83-90.
  • 3. 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(3):e0152676.
  • 4. Ashurst JV, Nappe TM. Methanol Toxicity. [Internet]. Treasure Island (FL). StatPearls Publishing, 2021.
  • 5. Vural S. Transdermal methanol ıntoxication via folk medicine. J Emerg Med Case Rep. 2019;10(2):50-2.
  • 6. Holt NR, Nickson CP. Severe methanol poisoning with neurological sequelae: implications for diagnosis and management. Intern Med J. 2018;48(3):335-9.
  • 7. Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department [digest]. Emerg Med Pract. 2016;18(9):S1-S2.
  • 8. Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: A systematic review and consensus statement. Crit Care Med. 2015;43(2):461-72.
  • 9. Sivilotti M, Sivilotti MLA, Burns MJ, Aaron CK, McMartin KE, Brent J. Reversal of severe methanol-induced visual impairment: No evidence of retinal toxicity due to fomepizole. J Toxicol - Clin Toxicol. 2001;39(6):627-31.
  • 10. McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016;81(3):505-15.
  • 11. Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the treatment of ethylene glycol poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999;37(5):537-60.
  • 12. Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, Saberinia A, Nasehi AA, Masoumi Asl H et al. Methanol mass poisoning in Iran: Role of case finding in outbreak management. J Public Heal (U. Kingdom). 2015;37(2):354-9.
  • 13. Schep LJ, Slaughter RJ, Vale JA, Beasley DMG. A seaman with blindness and confusion. BMJ. 2009;339:B3929.
  • 14. Sözcü Gazetesi. Erişim tarihi: 20 Nisan 2021: https://www.sozcu.com.tr/2020/gundem/son-dakika-kirikkalede-sahte-ickiden-7-kisi-hayatini-kaybetti-6073679/
  • 15. Evrensel Haber. Erişim tarihi: 20 Nisan 2021: https://www.evrensel.net/haber/416305/metil-alkol-zehirlenmesi-suphesiyle-15-gunde-73-kisi-yasamini-yitirdi
  • 16. Anadolu Ajansı. Erişim tarihi: 20 Nisan 2021: https://www.aa.com.tr/tr/turkiye/metil-alkol-zehirlenmesi-nedeniyle-15-gunde-71-kisi-oldu/2016389
  • 17. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes a multicenter study. Clin Toxicol. 2012;50(9):823-31.
  • 18. Resmî Gazete. Erişim tarihi: 20 Nisan 2021: https://www.resmigazete.gov.tr/eskiler/2019/01/20190109.pdf
  • 19. Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: Epidemiology, clinical features and prognostic signs. J Internal Med. 2005;258(2):181-90.
  • 20. Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P et al. Czech mass methanol outbreak 2012: Epidemiology, challenges and clinical features Clinical Toxicology. 2014;52(10):1013-24.
  • 21. Massoumi G, Saberi K, Eizadi-Mood N, Shamsi M, Alavi M, Morteza A. Methanol poisoning in Iran, from 2000 to 2009. Drug Chem Toxicol. 2012;35(3):330-3.
  • 22. Ahmed F, Khan NU, Ali N, Feroze A. Methanol poisoning: 27 years experience at a tertiary care hospital. J Pak Med Assoc. 2017;67(11):1751-2.
  • 23. Callaghan M. A drink to die for: Arak and methanol poisoning in Indonesia. Travel Med Infect Dis. 2015;13(6):507-8.
  • 24. 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.
  • 25. Yayci N, Ağritmiş H, Turla A, Koç S. Fatalities due to methyl alcohol intoxication in Turkey: an 8-year study. Forensic Sci Int. 2003;131(1):36-41.
  • 26. Celik S, Karapirli M, Kandemir E, Ucar F, Kantarci MN, Gurler M et al. Fatal ethyl and methyl alcohol-related poisoning in Ankara: A retrospective analysis of 10,720 cases between 2001 and 2011. J Forensic Leg Med. 2013;20(3):151-4.
  • 27. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila). 2007;45(2):152-7.
  • 28. Liu JJ, Daya MR, Carrasquillo O, Kales SN. Prognostic factors in patients with methanol poisoning. J Toxicol Clin Toxicol. 1998;36(3):175-8.

Retrospectıie Analysis of Patients Admıited to the Emergency Department Due to Methanol Poisoning

Year 2021, Volume: 23 Issue: 3, 530 - 537, 31.12.2021

Ertan Cömertpay Oğuz Eroğlu Turgut Deniz

https://doi.org/10.24938/kutfd.956874

Abstract

Objective: Methanol poisoning has become a frequently encountered type of poisoning in our country recently. In case of poisoning, mortality and morbidity rates can be reduced by rapidly recognizing and treating the cases. The aim of this study is to investigate the relationship between survival and the demographic characteristics, physical examination findings and laboratory results of methanol poisoning patients admitted to the emergency department.
Material and Methods: Patients were divided into 2 different groups as exitus after methanol poisoning and survivors after methanol poisoning. Demographic characteristics, presentation complaints, physical examination findings and laboratory results and clinical outcomes of all patients were recorded. Chi-square, Student t-test and Mann-Whitney U tests were used to compare the groups. A value of p<0.05 was considered statistically significant.
Results: A total of 17 patients, including exitus after methanol poisoning (n=5) and survivors (n=12), were included in the study. The most common complaint after methanol poisoning was visual impairment (70.6%), followed by shortness of breath (35.3%) and nausea-vomiting (35.3%). There was no difference between the groups in terms of admission complaints. The mean value of vital signs, especially respiratory rate (hyperventilation), was above the normal value in both groups. However, there was no difference between the groups in terms of vital signs. While creatinine level and base deficit level in the deceased patient group were significantly increased compared to those in the survivor group, bicarbonate and pH levels were found to be significantly decreased (p=0.015; 0.002, 0.020; 0.002, respectively).
Conclusion: In patients who died after methanol poisoning, increase in creatinine value and base deficiency, deepening acidosis and decreased bicarbonate level are consistent with poor clinical outcome. In cases of hyperventilation and loss of consciousness accompanying visual impairment, methanol poisoning should be considered and appropriate treatment procedures should be initiated as soon as possible.

Keywords

Formic acid Acid-Base balance Survival Acidosis Methanol

References

  • 1. Satar S, Güneysel Ö, Türedi S, Yürümez Y, Akıcı A. Klinik Toksikoloji Tanı ve Tedavi. Alkoller ve Glikoller. Antalya. Çukurova Nobel Tıp Kitabevi, 2020.
  • 2. Gulen M, Satar S, Avci A, Acehan S, Orhan U, Nazik H. Methanol poisoning in Turkey: Two outbreaks, a single center experience. Alcohol. 2020;88:83-90.
  • 3. 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(3):e0152676.
  • 4. Ashurst JV, Nappe TM. Methanol Toxicity. [Internet]. Treasure Island (FL). StatPearls Publishing, 2021.
  • 5. Vural S. Transdermal methanol ıntoxication via folk medicine. J Emerg Med Case Rep. 2019;10(2):50-2.
  • 6. Holt NR, Nickson CP. Severe methanol poisoning with neurological sequelae: implications for diagnosis and management. Intern Med J. 2018;48(3):335-9.
  • 7. Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department [digest]. Emerg Med Pract. 2016;18(9):S1-S2.
  • 8. Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: A systematic review and consensus statement. Crit Care Med. 2015;43(2):461-72.
  • 9. Sivilotti M, Sivilotti MLA, Burns MJ, Aaron CK, McMartin KE, Brent J. Reversal of severe methanol-induced visual impairment: No evidence of retinal toxicity due to fomepizole. J Toxicol - Clin Toxicol. 2001;39(6):627-31.
  • 10. McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016;81(3):505-15.
  • 11. Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the treatment of ethylene glycol poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999;37(5):537-60.
  • 12. Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, Saberinia A, Nasehi AA, Masoumi Asl H et al. Methanol mass poisoning in Iran: Role of case finding in outbreak management. J Public Heal (U. Kingdom). 2015;37(2):354-9.
  • 13. Schep LJ, Slaughter RJ, Vale JA, Beasley DMG. A seaman with blindness and confusion. BMJ. 2009;339:B3929.
  • 14. Sözcü Gazetesi. Erişim tarihi: 20 Nisan 2021: https://www.sozcu.com.tr/2020/gundem/son-dakika-kirikkalede-sahte-ickiden-7-kisi-hayatini-kaybetti-6073679/
  • 15. Evrensel Haber. Erişim tarihi: 20 Nisan 2021: https://www.evrensel.net/haber/416305/metil-alkol-zehirlenmesi-suphesiyle-15-gunde-73-kisi-yasamini-yitirdi
  • 16. Anadolu Ajansı. Erişim tarihi: 20 Nisan 2021: https://www.aa.com.tr/tr/turkiye/metil-alkol-zehirlenmesi-nedeniyle-15-gunde-71-kisi-oldu/2016389
  • 17. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes a multicenter study. Clin Toxicol. 2012;50(9):823-31.
  • 18. Resmî Gazete. Erişim tarihi: 20 Nisan 2021: https://www.resmigazete.gov.tr/eskiler/2019/01/20190109.pdf
  • 19. Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: Epidemiology, clinical features and prognostic signs. J Internal Med. 2005;258(2):181-90.
  • 20. Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P et al. Czech mass methanol outbreak 2012: Epidemiology, challenges and clinical features Clinical Toxicology. 2014;52(10):1013-24.
  • 21. Massoumi G, Saberi K, Eizadi-Mood N, Shamsi M, Alavi M, Morteza A. Methanol poisoning in Iran, from 2000 to 2009. Drug Chem Toxicol. 2012;35(3):330-3.
  • 22. Ahmed F, Khan NU, Ali N, Feroze A. Methanol poisoning: 27 years experience at a tertiary care hospital. J Pak Med Assoc. 2017;67(11):1751-2.
  • 23. Callaghan M. A drink to die for: Arak and methanol poisoning in Indonesia. Travel Med Infect Dis. 2015;13(6):507-8.
  • 24. 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.
  • 25. Yayci N, Ağritmiş H, Turla A, Koç S. Fatalities due to methyl alcohol intoxication in Turkey: an 8-year study. Forensic Sci Int. 2003;131(1):36-41.
  • 26. Celik S, Karapirli M, Kandemir E, Ucar F, Kantarci MN, Gurler M et al. Fatal ethyl and methyl alcohol-related poisoning in Ankara: A retrospective analysis of 10,720 cases between 2001 and 2011. J Forensic Leg Med. 2013;20(3):151-4.
  • 27. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila). 2007;45(2):152-7.
  • 28. Liu JJ, Daya MR, Carrasquillo O, Kales SN. Prognostic factors in patients with methanol poisoning. J Toxicol Clin Toxicol. 1998;36(3):175-8.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Ertan Cömertpay 0000-0002-8648-5963

Oğuz Eroğlu 0000-0001-7033-8566

Turgut Deniz 0000-0002-4774-4678

Publication Date December 31, 2021
Submission Date June 24, 2021
Published in Issue Year 2021 Volume: 23 Issue: 3

Cite

APA Cömertpay, E., Eroğlu, O., & Deniz, T. (2021). METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 23(3), 530-537. https://doi.org/10.24938/kutfd.956874
AMA Cömertpay E, Eroğlu O, Deniz T. METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ. Kırıkkale Uni Med J. December 2021;23(3):530-537. doi:10.24938/kutfd.956874
Chicago Cömertpay, Ertan, Oğuz Eroğlu, and Turgut Deniz. “METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23, no. 3 (December 2021): 530-37. https://doi.org/10.24938/kutfd.956874.
EndNote Cömertpay E, Eroğlu O, Deniz T (December 1, 2021) METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23 3 530–537.
IEEE E. Cömertpay, O. Eroğlu, and T. Deniz, “METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ”, Kırıkkale Uni Med J, vol. 23, no. 3, pp. 530–537, 2021, doi: 10.24938/kutfd.956874.
ISNAD Cömertpay, Ertan et al. “METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23/3 (December 2021), 530-537. https://doi.org/10.24938/kutfd.956874.
JAMA Cömertpay E, Eroğlu O, Deniz T. METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ. Kırıkkale Uni Med J. 2021;23:530–537.
MLA Cömertpay, Ertan et al. “METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 23, no. 3, 2021, pp. 530-7, doi:10.24938/kutfd.956874.
Vancouver Cömertpay E, Eroğlu O, Deniz T. METANOL ZEHİRLENMESİ NEDENİYLE ACİL SERVİSE BAŞVURAN HASTALARIN RETROSPEKTİF ANALİZİ. Kırıkkale Uni Med J. 2021;23(3):530-7.
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