Methanol Poisoning
Özet
Methanol poisoning (MP), caused by accidental or intentional exposure to toxic wood alcohol, presents a critical global healthcare challenge with significant morbidity and mortality, particularly in developing countries due to illegal alcohol production. Although methanol itself is non-toxic, its biotransformation in the liver via alcohol dehydrogenase produces highly toxic formaldehyde and subsequently formic acid. Formic acid accumulates rapidly due to its slow elimination rate, causing severe cellular dysfunction, metabolic acidosis with an elevated anion gap, and multi-organ failure. Humans are uniquely susceptible compared to primates or rats due to lower hepatic tetrahydrofolate concentrations. Toxicokinetics reveal rapid absorption within minutes through oral, dermal, or inhalation routes, with peak concentrations occurring in 30 to 60 minutes. Clinical manifestations progress after a 12-24 hour latent period, leading to gastrointestinal distress, central nervous system depression, and profound ocular toxicity ranging from blurred vision to permanent blindness caused by retinal and optic nerve damage. Severe complications include bilateral putaminal necrosis, acute kidney injury, and hepatocyte necrosis. Diagnosis relies heavily on history, clinical presentation, and tracking bicarbonate depletion. Effective management requires immediate antidote therapy using ethanol or fomepizole, folic acid supplementation, and hemodialysis for severe toxicity.
Referanslar
Ott J, Gronemann V, Pontzen F. Methanol. Ullmann’s Encyclopedia of Industrial Chemistry. 2000;27(2):403–404.
Holt NR, Nickson CP. Severe methanol poisoning with neurological sequelae: implications for diagnosis and management. Intern Med J. 2018;48(3):335-339.
Avsar MT, Toptas M, Demir E, Metin C. Methanol Intoxication in Patient due to the Chronic Usage of Alcohol and Cologne. Bezmialem Science 2017; 5: 183-5.
Chan AP, Chan TY. Methanol as an unlisted ingredient in supposedly alcohol-based hand rub can pose serious health risk. Int J Environ Res Public Health 2018;15:1440.
Anthon GE, Barrett DM. Characterization of the temperature activation of pectin methylesterase in green beans and tomatoes. J Agric Food Chem. 2006;54(1):204-211.
Ahmadabadi A, Sedaghat M, Ranjbar A, Poorolajal J, Nasiripour H, Ahmadabadi M. Quantitative analysis and health risk assessment of methanol in medicinal herbal drinks marketed in Hamadan, Iran. J. Appl. Pharmaceut. Sci. 2016;6(7):49–52.
Yousefi M, Afshari R, Sadeghi M, Salari R. Measurement of Methanol and Ethanol Contents in Most Commonly Used Herbal Distillates Produced by Three Famous Brands. Iran J Public Health. 2018;47(6):901-907.
Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department [digest]. Emerg Med Pract. 2016;18(9 Suppl Points & Pearls):S1-S2. Published 2016 Sep 22.
Liu JJ, Daya MR, Carrasquillo O, Kales SN. Prognostic factors in patients with methanol poisoning. J Toxicol Clin Toxicol. 1998;36(3):175-181.
Nekoukar Z, Zakariaei Z, Taghizadeh F, et al. Methanol poisoning as a new world challenge: A review. Ann Med Surg (Lond). 2021;66:102445.
Skrzydlewska E. Toxicological and metabolic consequences of methanol poisoning. Toxicol Mech Methods. 2003;13(4):277-93.
Zhai R, Zheng N, Rizak J, Hu X. Evidence for Conversion of Methanol to Formaldehyde in Nonhuman Primate Brain. Anal Cell Pathol (Amst). 2016;2016:4598454.
Ghorbani H, Nezami A, Sheikholeslami B, Hedjazi A, Ahmadimanesh M. Simultaneous measurement of formic acid, methanol and ethanol in vitreous and blood samples of postmortem by headspace GC-FID. J Occup Med Toxicol. 2018;13:1.
Zakharov S, Pelclova D, Diblik P, et al. Long-term visual damage after acute methanol poisonings: Longitudinal cross-sectional study in 50 patients. Clin Toxicol (Phila). 2015;53(9):884-892.
Song S, Timm S, Lindner SN, et al. Expression of Formate-Tetrahydrofolate Ligase Did Not Improve Growth but Interferes With Nitrogen and Carbon Metabolism of Synechocystis sp. PCC 6803. Front Microbiol. 2020;11:1650.
Bailey SW, Ayling JE. The extremely slow and variable activity of dihydrofolate reductase in human liver and its implications for high folic acid intake. Proc Natl Acad Sci U S A. 2009;106(36):15424-15429.
Lim CS, Bryant SM. Forgoing the Folate?-Contemporary Recommendations for Methanol Poisoning and Evidence Review. Am J Ther. 2016;23(3):e850-4.
Osterloh JD, D'Alessandro A, Chuwers P, Mogadeddi H, Kelly TJ. Serum concentrations of methanol after inhalation at 200 ppm. J Occup Environ Med. 1996;38(6):571-576.
Hovda KE, Andersson KS, Urdal P, Jacobsen D. Methanol and formate kinetics during treatment with fomepizole. Clin Toxicol (Phila). 2005;43(4):221-7.
Chung JY, Ho CH, Chen YC, et al. Association between acute methanol poisoning and subsequent mortality: a nationwide study in Taiwan. BMC Public Health. 2018;18(1):985.
Doreen B, Eyu P, Okethwangu D, et al. Fatal Methanol Poisoning Caused by Drinking Adulterated Locally Distilled Alcohol: Wakiso District, Uganda, June 2017. J Environ Public Health. 2020;2020:5816162.
Rossow I, Bogstrand ST, Ekeberg Ø, Normann PT. Associations between heavy episodic drinking and alcohol related injuries: a case control study. BMC Public Health. 2013;13:1076.
Ashurst JV, Nappe TM. Methanol Toxicity. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482121/
Daniel M, Rencic J, Durning SJ, et al. Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. Acad Med. 2019;94(6):902-912.
Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and treatment. Clin J Am Soc Nephrol. 2010;3: 194-201.
Zakharov S, Hlusicka J, Nurieva O, et al. Neuroinflammation markers and methyl alcohol induced toxic brain damage. Toxicol Lett. 2018;298:60-69.
Moral AR, Çankayalı İ, Sergin D, Boyacılar Ö. Neuromuscular Functions on Experimental Acute Methanol Intoxication. Turk J Anaesthesiol Reanim. 2015;43(5):337-343.
Palmisano J, Gruver C, Adams ND. Absence of anion gap metabolic acidosis in severe methanol poisoning: a case report and review of the literature. Am J Kidney Dis. 1987;9(5):441-4.
Galvez-Ruiz A, Elkhamary SM, Asghar N, Bosley TM. Visual and neurologic sequelae of methanol poisoning in Saudi Arabia. Saudi Med J. 2015;36(5):568-574.
Işcan Y, Coşkun Ç, Öner V, Türkçü FM, Taş M, Alakuş MF. Bilateral total optic atrophy due to transdermal methanol intoxication. Middle East Afr J Ophthalmol. 2013;20(1):92-94.
Bezdicek O, Michalec J, Vaneckova M, et al. Cognitive sequelae of methanol poisoning involve executive dysfunction and memory impairment in cross-sectional and long-term perspective. Alcohol. 2017;59:27-35.
Verhelst D, Moulin P, Haufroid V, Wittebole X, Jadoul M, Hantson P. Acute renal injury following methanol poisoning: analysis of a case series. Int J Toxicol. 2004;23(4):267-73.
Akhgari M, Panahianpour MH, Bazmi E, Etemadi-Aleagha A, Mahdavi A, Nazari SH. Fatal methanol poisoning: features of liver histopathology. Toxicol Ind Health. 2013;29(2):136-41.
Ng PC, Long BJ, Davis WT, Sessions DJ, Koyfman A. Toxic alcohol diagnosis and management: An emergency medicine review. Internal and Emergency Medicine. 2018; 13(3):375-83.
Mégarbane B. Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open Access Emerg Med. 2010;2:67-75
Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American academy of clinical toxicology practice guidelines on the treatment of methanol poisoning. Journal of Toxicology: Clinical Toxicology. 2002; 40(4):415-46
Gallagher N, Edwards FJ. The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Adv J Emerg Med. 2019;3(3):e28.
