Öz
Amaç: Metanol zehirlenmesi oküler, nörolojik, metabolik ve gastrointestinal bulguları ile iyi bilinir, fakat kalp etkileri literatürde nadir görülmektedir. Hastalar sıklıkla tanıklı alkol alım öyküsü ile hastaneye başvurmaktadır.
Olgu Sunumu: Bu vaka sırt ağrısı ile hastaneye başvurdu. ST segment yükselmeli miyokard infarktüsü (STEMI) tespit edildi. Klinik bulgulara göre, metanol zehirlenmesi de saptandı. Vaka 34 yaşında erkek hasta ambulansla ağır bel ağrısı şikayeti ile hastaneye yatırıldı. Oryante ve koopereydi. GCS skoru 15 idi. Hayati bulguları TA 90/50 mmHg, kan oksijen satürasyonu % 92, nabız 110/bpm olduğu görüldü. Elektrokardiyografide (EKG) inferolateral ST yükselmesi kaydedildi. Monitörizasyon sırasında göz teması eksikliği devam etti, görüşünü son 3 saattir kaybettiğini belirtti. Bir gece önce bir şişe kolonya içtiğini (şişenin büyüklüğü belli değil) ifade etti. Hastanın kan gazı testi pH 6,8, HCO3 6, baz fazlalığı -34mmol/l olarak gösterdi. Biyokimyasal incelemede kan üre azotu (BUN) 42 mg/dl, kreatinin 1,1 mg/dl idi. Tam kan sayımı hemoglobin 14,5 g/dl ve beyaz kan hücresi (WBC) 16,500/mm3 idi. Giriş sırasındaki kan metanol seviyesi 156 mg/ml idi.
Sonuç: Metanol zehirlenmesinin EKG bulguları sınırlıdır. Önceki raporlarda, eksen değişiklikleri, spesifik olmayan T dalgası değişiklikleri, QRS karmaşık değişiklikleri ve uzun QTc aralıkları kaydedilmiştir. Literatürdeki bu vakaların sınırlı sayıda olduğu göz önüne alındığında, bu popülasyonun sistematik EKG analizi henüz bildirilmemiştir. Koroner anjiyografide tüm koroner damarların normal olduğu gösterilmiştir.
Doktorlar alternatif tanı için her zaman uyanık olmalı ve detaylı anamnez almalıdır. Belirgin, farklı bir tanısı olan bir hastanın sürekli klinik şüphesi bizi başka ve doğru bir sonuca götürdü.
Anahtar Kelimeler
Kaynakça
- Prabhakaran V, Ettler H, Mills A. Methanol poisoning: two cases with similar plasma methanol concentrations but different outcomes. CMAJ 1993;148:981-984.
- Pamies RJ, Sugar D, Rives LA, et al. Methanol intoxication. How to help patients who have been exposed to toxic solvents. Postgrad Med. 1993;93(8):183-4, 189-91, 194. doi: 10.1080/00325481.1993.11701725. PMID: 8389447.
- Algahtani H, Shirah B, Ahmad R, et al. Transverse myelitis-like presentation of methanol intoxication: A case report and review of the literature. J Spinal Cord Med. 2018;41(1):72-76. doi:10.1080/10790268.2016.1226005.
- Onder F, Ilker S, Kansu T, et al. Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol 1999;22 :81-84.
- McLean DR, Jacobs H, Mielke BW. Methanol poisoning: A clinical and pathological study. Ann Neurol 1980;8:161-167.
- Koivusalo, M. Methanol. In: Tremolieres, J. (sectioned) IntEncyclPharmacolTher. Sec. 20 vol II. AlcoholsandDerivatives. PergamonPress, New York, 1970, pp 465-505.
- McMartin CE, Ambre JJ, Tephly TR. Methanol poisoning in human subjects. Role for formic acid accumulation in the metabolic acidosis. Am J Med 1980;68: 414–418.
- Kraut JA, Madias NE. Metabolica cidosis:Pathophysiology, diagnosis and management. Nat Rev Nephrol 2010;6: 274–285.
- Gadodia A, Singhal B, Sharma R. Methanol intoxication causing putaminal necrosis. J Emerg Trauma Shock 2011;4(2):300–1.
- Nazir S, Melnick S, Ansari S, Kanneh HT. Mind the gap: a case of severe methanol intoxication. BMJ Case Rep. 2016;2016:bcr2015214272. doi: 10.1136/bcr-2015-214272.
- Rowe VK, McCollister SB. Alcohols. In: Clayton GD, Clayton FE, eds. Patty’s industrial hygiene and toxicology: Vol. 2C, Toxicology. New York: John Wiley&Sons, 1982:4533.
- Andresen H, Schmoldt H, Matschke J, et al. Fatal methanol intoxication with different survival times—morphological findings and postmortem methanol distribution. Forensic Sci Int 2008;179(2–3):206–10.
Öz
Aim: Methanol intoxication is well known for its ocular, neurologic, metabolic and gastrointestinal findings but cardiac effects are rarely found in literature. Patients often admit to hospital with a witnessed alcohol intake history.
Case Report: This case had admitted to the hospital with back pain. He had ST segment elevated myocardial infarction (STEMI). According to the clinical findings, methanol intoxication was also detected. Case A 34 years old male patient was admitted to the hospital with severe back pain via ambulance. He was oriented and cooperated. His GCS score was 15. His vital findings revealed TA 90/50 mmHg, blood oxygen saturation 92%, pulse 110/bpm. On electrocardiography (ECG) inferolateral ST elevation was noted. During monitorization, lack of eye contact continued, he stated that he lost sight for 3 hours. He stated that he had consumed a bottle of cologne (the size of the bottle is unclear) the night before. The patient’s blood gas test revealed pH 6,8, HCO3 6, base excess -34mmol/l. On biochemical examination, blood urea nitrogen (BUN) was 42 mg/dl, creatinine was 1,1 mg/dl. His complete blood count revealed hemoglobin 14,5 g/dl and white blood cell (WBC) 16,500/mm3. The blood methanol level at admission was 156 mg/ml.
Conclusion: The ECG findings of methanol intoxication are limited. Previous reports have documented axis variations, non-specific T wave changes, QRS complex alterations and prolonged QTc intervals. Taking into consideration the limited number of these cases in literature, the systematic ECG analysis of this population has not been reported yet. In coronary angiography, it is shown that all the coronary vessels were normal.
Physicians should always be alert for alternative diagnosis and should take detailed anamnesis. Our sustained clinical suspicion of a patient with an obvious different diagnosis has taken us to another and accurate result.
Anahtar Kelimeler
Kaynakça
- Prabhakaran V, Ettler H, Mills A. Methanol poisoning: two cases with similar plasma methanol concentrations but different outcomes. CMAJ 1993;148:981-984.
- Pamies RJ, Sugar D, Rives LA, et al. Methanol intoxication. How to help patients who have been exposed to toxic solvents. Postgrad Med. 1993;93(8):183-4, 189-91, 194. doi: 10.1080/00325481.1993.11701725. PMID: 8389447.
- Algahtani H, Shirah B, Ahmad R, et al. Transverse myelitis-like presentation of methanol intoxication: A case report and review of the literature. J Spinal Cord Med. 2018;41(1):72-76. doi:10.1080/10790268.2016.1226005.
- Onder F, Ilker S, Kansu T, et al. Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol 1999;22 :81-84.
- McLean DR, Jacobs H, Mielke BW. Methanol poisoning: A clinical and pathological study. Ann Neurol 1980;8:161-167.
- Koivusalo, M. Methanol. In: Tremolieres, J. (sectioned) IntEncyclPharmacolTher. Sec. 20 vol II. AlcoholsandDerivatives. PergamonPress, New York, 1970, pp 465-505.
- McMartin CE, Ambre JJ, Tephly TR. Methanol poisoning in human subjects. Role for formic acid accumulation in the metabolic acidosis. Am J Med 1980;68: 414–418.
- Kraut JA, Madias NE. Metabolica cidosis:Pathophysiology, diagnosis and management. Nat Rev Nephrol 2010;6: 274–285.
- Gadodia A, Singhal B, Sharma R. Methanol intoxication causing putaminal necrosis. J Emerg Trauma Shock 2011;4(2):300–1.
- Nazir S, Melnick S, Ansari S, Kanneh HT. Mind the gap: a case of severe methanol intoxication. BMJ Case Rep. 2016;2016:bcr2015214272. doi: 10.1136/bcr-2015-214272.
- Rowe VK, McCollister SB. Alcohols. In: Clayton GD, Clayton FE, eds. Patty’s industrial hygiene and toxicology: Vol. 2C, Toxicology. New York: John Wiley&Sons, 1982:4533.
- Andresen H, Schmoldt H, Matschke J, et al. Fatal methanol intoxication with different survival times—morphological findings and postmortem methanol distribution. Forensic Sci Int 2008;179(2–3):206–10.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Vaka Takdimi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 3 Sayı: 3 |
