Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks.

Sergey Zakharov
Sergey Zakharov
Toxicological Information Center
Katerina Kotikova
Katerina Kotikova
a Toxicological Information Center
Daniela Pelclova
Daniela Pelclova
University of Geneva
Knut Erik Hovda
Knut Erik Hovda
Ullevaal University Hospital

Ann Intensive Care 2017 Dec 20;7(1):77. Epub 2017 Jul 20.

The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.

Background: Intermittent hemodialysis (IHD) is the modality of choice in the extracorporeal treatment (ECTR) of acute methanol poisoning. However, the comparative clinical effectiveness of intermittent versus continuous modalities (CRRT) is unknown. During an outbreak of mass methanol poisoning, we therefore studied the effect of IHD versus CRRT on mortality and the prevalence of visual/central nervous system (CNS) sequelae in survivors.

Methods: The study was designed as prospective observational cohort study. Patients hospitalized with a diagnosis of acute methanol poisoning were identified for the study. Exploratory factor analysis and multivariate logistic regression were applied to determine the effect of ECTR modality on the outcome.

Results: Data were obtained from 41 patients treated with IHD and 40 patients with CRRT. The follow-up time in survivors was two years. Both groups of patients were comparable by age, time to presentation, laboratory data, clinical features, and other treatment applied. The CRRT group was more acidemic (arterial blood pH 6.96 ± 0.08 vs. 7.17 ± 0.07; p < 0.001) and more severely poisoned (25/40 vs. 9/41 patients with Glasgow Coma Scale (GCS) ≤ 8; p < 0.001). The median intensive care unit length of stay (4 (range 1-16) days vs. 4 (1-22) days; p = 0.703) and the number of patients with complications during the treatment (11/41 vs. 13/40 patients; p = 0.576) did not differ between the groups. The mortality was higher in the CRRT group (15/40 vs. 5/41; p = 0.008). The number of survivors without sequelae of poisoning was higher in the IHD group (23/41 vs. 10/40; p = 0.004). There was a significant association of ECTR modality with both mortality and the number of survivors with visual and CNS sequelae of poisoning, but this association was not present after adjustment for arterial blood pH and GCS on admission (all p > 0.05).

Conclusions: In spite of the faster correction of the acidosis and the quicker removal of the toxic metabolite in intermittent dialysis, we did not find significant differences in the treatment outcomes between the two groups after adjusting for the degree of acidemia and the severity of poisoning on admission. These findings support the strategy of "use what you have" in situations with large outbreaks and limited dialysis capacity.

Download full-text PDF

Source Listing
December 2017
38 Reads

Publication Analysis

Top Keywords

methanol poisoning
acute methanol
versus continuous
intermittent versus
clinical effectiveness
designed prospective
survivorsmethods study
time presentation
study designed
observational cohort
age time
patients hospitalized
comparable age
study patients
sequelae survivorsmethods
cohort study
prospective observational
system cns


(Supplied by CrossRef)
Article in J Intern Med
KE Hovda et al.
J Intern Med 2005
Article in Clin Toxicol
R Paasma et al.
Clin Toxicol 2007
Article in J Public Health
H Hassanian-Moghaddam et al.
J Public Health 2015
Article in PLoS ONE
M Rostrup et al.
PLoS ONE 2016
Article in Intensive Care Med
B Megarbane et al.
Intensive Care Med 2005
Article in Brit J Pharmacol
K McMartin et al.
Brit J Pharmacol 2016
Article in Pharmacol Toxicol
J Liesivuori et al.
Pharmacol Toxicol 1991
Article in Acta Med Scand
OM Sejersted et al.
Acta Med Scand 1983
Article in J Appl Biomed
S Zakharov et al.
J Appl Biomed 2014
Article in Cesk Slov Neurol N
O Bezdicek et al.
Cesk Slov Neurol N 2014

Similar Publications