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Safari H, Ajudani R, Savaie M, Babadi AJ, Alizadeh P. Intracerebral hemorrhage in methanol toxicity patients during COVID-19 pandemic: case report and review of literature. Forensic Toxicol 2024; 42:242-247. [PMID: 38334843 DOI: 10.1007/s11419-023-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study is to examine the clinical and imaging manifestations of methanol toxicity during the COVID-19 pandemic, as well as to review existing studies on this topic. The most common cause of methanol intoxication is methanol-adulterated liquor. The primary metabolite of methanol, formic acid, is responsible for pathological changes. Symptoms typically present within 6-24 h of consumption and can include visual disturbances, acute neurological symptoms, and gastrointestinal issues. During the initial year of the COVID-19 pandemic, methanol poisoning cases increased significantly. METHODS In this study, We present six different patients with methanol intoxication and their clinical and imaging features. RESULTS In the literature review, the most common clinical presentation was loss of consciousness and obtundation and the other was vision loss. CT scan findings showed bilateral putaminal necrosis and hemorrhage in 55% of methanol toxicity patients. CONCLUSION Methanol intoxication, causing bilateral putaminal involvement and a 50% mortality rate in intracerebral hemorrhage patients, warrants urgent toxicological analysis due to potential putaminal hemorrhage.
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Affiliation(s)
- Hosein Safari
- Pain Research Center, Neurosurgery department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Ajudani
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pooyan Alizadeh
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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2
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Pinto C. Why is this patient acutely altered? JAAPA 2024; 37:47-49. [PMID: 38985117 DOI: 10.1097/01.jaa.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Chelsey Pinto
- Chelsey Pinto practices in critical care and hospitalist medicine at Corewell Health Pennock Hospital in Hastings, Mich. The author has disclosed no potential conflicts of interest, financial or otherwise
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3
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Ogburn T, Chaudhry I, Knight LD. When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice. Am J Forensic Med Pathol 2024:00000433-990000000-00190. [PMID: 38833354 DOI: 10.1097/paf.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.
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Affiliation(s)
- Timothy Ogburn
- From the University of Nevada-Reno School of Medicine, Reno, NV
| | - Irfan Chaudhry
- Washoe County Regional Medical Examiner's Office, and Department of Pathology, University of Nevada-Reno School of Medicine, Reno, NV
| | - Laura D Knight
- Washoe County Regional Medical Examiner's Office, and Departments of Pathology and Pediatrics, University of Nevada-Reno School of Medicine, Reno, NV
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4
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King K, Smith R, Johnson G. Toxic household exposures in children. BMJ 2024; 385:e077046. [PMID: 38702067 DOI: 10.1136/bmj-2023-077046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Affiliation(s)
- Kate King
- Academic Department of Military General Practice, Defence Medical Services, ICT Centre, Birmingham Research Park, Birmingham B15 2SQ, UK
| | - Rachel Smith
- Department of Paediatrics, West Cumberland Hospital, Whitehaven CA28 8JG, UK
| | - Graham Johnson
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
- Medical School, University of Nottingham, Lenton, Nottingham NG7 2UH, UK
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5
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Alhusain F, Alshalhoub M, Homaid MB, Esba LCA, Alghafees M, Al Deeb M. Clinical presentation and management of methanol poisoning outbreaks in Riyadh, Saudi Arabia: a retrospective analysis. BMC Emerg Med 2024; 24:64. [PMID: 38627622 PMCID: PMC11020920 DOI: 10.1186/s12873-024-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Acute methanol intoxication, whether unintentional or deliberate, necessitates prompt intervention to prevent severe morbidity and mortality. Homemade alcoholic beverages are a frequent source of such poisoning. This retrospective analysis examined two outbreaks of methanol intoxication in Saudi Arabia. It investigated the clinical presentation, implemented management strategies, and any lasting complications (sequelae) associated with these cases. The aim was to assess the potential impact of different treatment modalities and the timeliness of their initiation on patient outcomes. METHODS This was a retrospective case series of methanol poisoning cases which presented to the adult emergency department (ED) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. There were two separate outbreaks in the city, the first one was from September 1 to September 10, 2020 and the second one was from May 14 to May 20, 2021. Electronic charts were reviewed, and data were extracted to previously prepared data extraction sheets. RESULT From the 22 patients who arrived in the ED alive, the most common complaints were nausea or vomiting followed by altered level of consciousness. About 9% from the patient were hypotensive, 36% were tachycardic, 41% were tachypneic and 4% were having SpO2 < 94%. Brain CT was abnormal in 6 patients. Vision impairment was the most common sequalae of methanol poisoning (7 out of 12 patients who were assessed by ophthalmologist, 58%). When the patients were divided based on severity (mild, moderate, severe), nausea or vomiting and loss of consciousness were the most common complaints among the moderate group while loss of consciousness predominated in the severe group. Two patients presented with low blood pressure and were in the sever group. The severe group had a mean Glasgow Coma Scale (GCS) of 8. Most of the patients in the severity groups underwent the same management apart from those who died or deposited. Eight patients in the severe group had to be intubated. CONCLUSION This study demonstrates the multifaceted clinical presentation of methanol poisoning, culminating in a 17.4% mortality rate. Notably, our findings emphasize the critical role of prompt diagnosis and swift initiation of combined fomepizole therapy and hemodialysis in mitigating mortality and minimizing the potential for chronic visual sequelae associated with methanol poisoning.
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Affiliation(s)
- Faisal Alhusain
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Mohammed Alshalhoub
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Moath Bin Homaid
- Emergency Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laila Carolina Abu Esba
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Alghafees
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Surgery Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Al Deeb
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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6
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Kolosionek TJ, Amaducci AM, Fikse DJ, Katz KD. Combined Ethylene Glycol Poisoning with Methemoglobinemia Due to Antifreeze Ingestion. J Emerg Med 2023; 65:e438-e440. [PMID: 37734990 DOI: 10.1016/j.jemermed.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 06/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Antifreeze poisoning is potentially life-threatening and often requires multiple antidotal therapies and hemodialysis. Ethylene or propylene glycol toxicity is commonly caused by antifreeze ingestion. However, ingestion of antifreeze is typically not associated with methemoglobinemia. Currently, only one other case of antifreeze ingestion causing combined ethylene glycol poisoning and methemoglobinemia has been reported. CASE REPORT A 56-year-old man presented after a witnessed, intentional, large-volume antifreeze ingestion. Evaluation revealed dark brown blood and significantly elevated methemoglobin and ethylene glycol levels. He was successfully treated with methylene blue, fomepizole, and hemodialysis. No other potential cause for methemoglobinemia was elucidated, and further research indicated that minor components of the specific antifreeze product served as an oxidizing agent. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the impact of minor, unreported product components that may significantly contribute to clinical toxicity, as well as the need to remain vigilant when reviewing product information and potential limitations therein.
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Affiliation(s)
- Timothy J Kolosionek
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
| | - Alexandra M Amaducci
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
| | - Derek J Fikse
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
| | - Kenneth D Katz
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
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Jose KP, Ravi S, Sivadas DK, Anthony SP, Madhu V. Fluorometric Detection of Methanol by Using Triphenylamine Fluorophore Tethered Terpyridine Probe. ChemistrySelect 2023. [DOI: 10.1002/slct.202204978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Karolin P. Jose
- Department of Applied Chemistry Karunya Institute of Technology and Sciences Coimbatore 641 114 Tamil Nadu India
| | - Sasikala Ravi
- School of Chemical & Biotechnology SASTRA Deemed University Thanjavur 613401 Tamil Nadu India
| | - Deepanjaly K. Sivadas
- Department of Applied Chemistry Karunya Institute of Technology and Sciences Coimbatore 641 114 Tamil Nadu India
| | | | - Vedichi Madhu
- Department of Applied Chemistry Karunya Institute of Technology and Sciences Coimbatore 641 114 Tamil Nadu India
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8
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Almeida SI, Oliveira S, Matos E, Abecasis F. Acute Kidney Injury with Hyperlactatemia: Clues to a Hidden Problem. ACTA MEDICA PORT 2023; 36:223-224. [PMID: 36898207 DOI: 10.20344/amp.19375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Sara Isabel Almeida
- Pediatric Intensive Care Unit. Pediatric Department. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa; Pediatric Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - Sara Oliveira
- Pediatric Intensive Care Unit. Pediatric Department. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa; Pediatric Department. Hospital Beatriz Ângelo. Loures. Portugal
| | - Eugénia Matos
- Pediatric Intensive Care Unit. Pediatric Department. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Francisco Abecasis
- Pediatric Intensive Care Unit. Pediatric Department. Hospital Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
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Inman B, Maddry JK, Ng PC, Koyfman A, Long B. High risk and low prevalence diseases: Toxic alcohol ingestion. Am J Emerg Med 2023; 67:29-36. [PMID: 36796238 DOI: 10.1016/j.ajem.2023.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Toxic alcohol ingestion is a rare but serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of toxic alcohol ingestion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Toxic alcohols include ethylene glycol, methanol, isopropyl alcohol, propylene glycol, and diethylene glycol. These substances can be found in several settings including hospitals, hardware stores, and the household, and ingestion can be accidental or intentional. Toxic alcohol ingestion presents with various degrees of inebriation, acidemia, and end-organ damage depending on the substance. Timely diagnosis is critical to prevent irreversible organ damage or death and is based primarily on clinical history and consideration of this entity. Laboratory evidence of toxic alcohol ingestion includes worsening osmolar gap or anion-gap acidemia and end organ injury. Treatment depends on the ingestion and severity of illness but includes alcohol dehydrogenase blockade with fomepizole or ethanol and special considerations for the initiation of hemodialysis. CONCLUSIONS An understanding of toxic alcohol ingestion can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brannon Inman
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Joseph K Maddry
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Patrick C Ng
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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10
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Tonezzer M, Bazzanella N, Gasperi F, Biasioli F. Nanosensor Based on Thermal Gradient and Machine Learning for the Detection of Methanol Adulteration in Alcoholic Beverages and Methanol Poisoning. SENSORS 2022; 22:s22155554. [PMID: 35898057 PMCID: PMC9329758 DOI: 10.3390/s22155554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/01/2023]
Abstract
Methanol, naturally present in small quantities in the distillation of alcoholic beverages, can lead to serious health problems. When it exceeds a certain concentration, it causes blindness, organ failure, and even death if not recognized in time. Analytical techniques such as chromatography are used to detect dangerous concentrations of methanol, which are very accurate but also expensive, cumbersome, and time-consuming. Therefore, a gas sensor that is inexpensive and portable and capable of distinguishing methanol from ethanol would be very useful. Here, we present a resistive gas sensor, based on tin oxide nanowires, that works in a thermal gradient. By combining responses at various temperatures and using machine learning algorithms (PCA, SVM, LDA), the device can distinguish methanol from ethanol in a wide range of concentrations (1–100 ppm) in both dry air and under different humidity conditions (25–75% RH). The proposed sensor, which is small and inexpensive, demonstrates the ability to distinguish methanol from ethanol at different concentrations and could be developed both to detect the adulteration of alcoholic beverages and to quickly recognize methanol poisoning.
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Affiliation(s)
- Matteo Tonezzer
- Research and Innovation Centre, Fondazione Edmund Mach, via E. Mach 1, 38010 San Michele all’Adige, Italy; (F.G.); (F.B.)
- Center Agriculture Food Environment, University of Trento/Fondazione Edmund Mach, via E. Mach 1, 38010 San Michele all’Adige, Italy
- IMEM-CNR, Sede di Trent o-FBK, Via alla Cascata 56/C, Povo, 38123 Trento, Italy
- Correspondence: ; Tel.: +39-0461-314-828
| | - Nicola Bazzanella
- Department of Physics, Università degli Studi di Trento, Povo, 38123 Trento, Italy;
| | - Flavia Gasperi
- Research and Innovation Centre, Fondazione Edmund Mach, via E. Mach 1, 38010 San Michele all’Adige, Italy; (F.G.); (F.B.)
- Center Agriculture Food Environment, University of Trento/Fondazione Edmund Mach, via E. Mach 1, 38010 San Michele all’Adige, Italy
| | - Franco Biasioli
- Research and Innovation Centre, Fondazione Edmund Mach, via E. Mach 1, 38010 San Michele all’Adige, Italy; (F.G.); (F.B.)
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11
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YURTSEVER G, ARIKAN C, ACAR H, SORGUN O, BORA ES. Methanol poisoning in the emergency department: a retrospective study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1095045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Massive methanol poisonings have occurred in the past decades, resulting in a large number of deaths. In this study, our aim is to retrospectively analyze methanol poisoning cases admitted to the emergency department between 2019-2021, to evaluate their demographic characteristics, causes of poisoning, clinical and laboratory findings, treatments applied and mortality, and to contribute to the poisoning data of our country.
Material and Method: The cases of methanol poisoning who applied to the emergency department in a 3-year period were analyzed retrospectively. Medical files of patients aged 18 years and older were reviewed. Patients diagnosed with 'methanol poisoning' as a result of the examination were included in the study.
Results: A total of 59 patients were included in the study. 88% (n=52) of the patients with a mean age of 53±10 were male. The presence of neurological symptoms and GCS were associated with mortality among the symptoms of patients presenting to the emergency department (p=0.017, p
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12
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PANI-CNTs Microstructure with Interconnected NiO–NiOOH Particles as Selective Sensing Interface for Methanol Electrochemical Sensor. J CLUST SCI 2022. [DOI: 10.1007/s10876-022-02297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Stašinskis R, Stašinska K, Mukāns M, Graudiņš A, Liguts V, Lejnieks A. Changes in ionized calcium in ethylene glycol poisoning. Proc AMIA Symp 2022; 35:460-465. [DOI: 10.1080/08998280.2022.2062550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Roberts Stašinskis
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
| | | | | | - Andis Graudiņš
- Riga Stradins University, Riga, Latvia
- Monash Health at Monash University, Melbourne, Australia
| | - Viesturs Liguts
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
| | - Aivars Lejnieks
- Riga East University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
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Agerholm JS, Hansen KS, Voogd HL, Krogh AKH. Ethylene glycol toxicosis in milk-fed dairy calves. Acta Vet Scand 2022; 64:7. [PMID: 35331297 PMCID: PMC8944023 DOI: 10.1186/s13028-022-00626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethylene glycol (EG) (antifreeze) toxicosis has mostly been reported in dogs and cats, while reports on EG toxicosis in cattle are sparse. We report EG toxicosis in 25 milk-fed calves associated with a leak in the cooling pipes in a milk taxi. The milk taxi was connected to a geothermal heating system in which EG was used as antifreeze. CASE PRESENTATION Although the assistant responsible for feeding milk to the calves observed a few blue-colored droplets of liquid on the surface of the milk in the milk taxi and suspected EG contamination, the milk was fed to the calves. Within hours, the calves became depressed and some died within the next 2 days. Necropsy and histopathology revealed widespread severe acute renal tubular necrosis with numerous birefringent crystals in the tubular lumen. Biochemical analysis of serum showed severe damage to the kidneys (marked azotemia) and hypochloremia, hyponatremia and hyperkalemia; findings consisting with metabolic acidosis. After feeding the calves, the assistant inspected the milk taxi and found a leaking cooling pipe. CONCLUSIONS The suspected EG toxicosis was confirmed by the observation of renal tubular necrosis, numerous intratubular crystals, and metabolic acidosis. EG toxicosis due to leaking pipes connected to a geothermal heating system has not been reported previously. Alternative antifreeze products that are less toxic than EG are recommended for use if there is a risk of contamination of human and animal foodstuffs in case of a leak in the system.
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Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, Teresiński G, Buszewicz G, Januszewski J, Flieger J. Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053092. [PMID: 35270784 PMCID: PMC8910489 DOI: 10.3390/ijerph19053092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.
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Affiliation(s)
- Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
- Correspondence:
| | - Joanna Kobak
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Magdalena Tyczyńska
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Iga Dudek
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Amr Maani
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Grzegorz Buszewicz
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jacek Januszewski
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland;
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Rosenstock JL, Joab TMJ, DeVita MV, Yang Y, Sharma PD, Bijol V. Oxalate nephropathy: a review. Clin Kidney J 2022; 15:194-204. [PMID: 35145635 PMCID: PMC8825217 DOI: 10.1093/ckj/sfab145] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
This review describes the clinical and pathological features of oxalate nephropathy (ON), defined as a syndrome of decreased renal function associated with deposition of calcium oxalate crystals in kidney tubules. We review the different causes of hyperoxaluria, including primary hyperoxaluria, enteric hyperoxaluria and ingestion-related hyperoxaluria. Recent case series of biopsy-proven ON are reviewed in detail, as well as the implications of these series. The possibility of antibiotic use predisposing to ON is discussed. Therapies for hyperoxaluria and ON are reviewed with an emphasis on newer treatments available and in development. Promising research avenues to explore in this area are discussed.
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Affiliation(s)
- Jordan L Rosenstock
- Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Tatyana M J Joab
- Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Maria V DeVita
- Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Yihe Yang
- Department of Pathology, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, New York, USA
| | - Purva D Sharma
- Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, New York, NY, USA
| | - Vanesa Bijol
- Department of Pathology, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, New York, USA
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Roy S, Das S, Ray A, Parui PP. Fluorometric trace methanol detection in ethanol and isopropanol in a water medium for application in alcoholic beverages and hand sanitizers. RSC Adv 2021; 11:30093-30101. [PMID: 35480280 PMCID: PMC9040838 DOI: 10.1039/d1ra05201b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
Detection of methanol (MeOH) in an ethanol (EtOH)/isopropanol (iPrOH) medium containing water is crucial to recognize MeOH poisoning in alcoholic beverages and hand sanitizers. Although chemical sensing methods are very sensitive and easy to perform, the chemical similarities between the alcohols make MeOH detection very challenging particularly in the presence of water. Herein, the fluorometric detection of a trace amount of MeOH in EtOH/iPrOH in the presence of water using alcohol coordinated Al(iii)-complexes of an aldehydic phenol ligand containing a dangling pyrazole unit is described. The presence of MeOH in the EtOH/iPrOH causes a change of the complex geometry from tetrahedral (Td) to octahedral (Oh) due to the replacement of the coordinated EtOH/iPrOH by MeOH molecules. The Td-complex exhibited fluorescence but the Oh-species did not, because of the intramolecular photo-induced electron transfer (PET). By interacting the Oh species with water, its one MeOH coordination is replaced by a water molecule followed by the proton transfer from the water to pyrazole-N which generates strong fluorescence by inhibiting the PET. In contrast, the water interaction dissociates the Td-complex to exhibit fluorescence quenching. The water induced reversal of the fluorescence response from the decrease to increase between the absence and presence of MeOH is utilized to detect MeOH in an EtOH/iPrOH medium containing water with a sensitivity of ∼0.03–0.06% (v/v). The presence of water effected the MeOH detection and allows the estimation of the MeOH contamination in alcoholic beverages and hand sanitizers containing large amounts of water. Detection of MeOH in EtOH/iPrOH and commercial samples based on water induced reversal of fluorescence response from the decrease to increase between the absence and presence of MeOH.![]()
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Affiliation(s)
- Snigdha Roy
- Department of Chemistry, Jadavpur University Kolkata 700032 India +91-33-24146223 +91-9433490492
| | - Sanju Das
- Department of Chemistry, Maulana Azad College Kolkata 700013 India
| | - Ambarish Ray
- Department of Chemistry, Barasat Govt. College Kolkata 700124 India +91-9836650180
| | - Partha Pratim Parui
- Department of Chemistry, Jadavpur University Kolkata 700032 India +91-33-24146223 +91-9433490492
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18
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Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients 2021; 13:2777. [PMID: 34444939 PMCID: PMC8401155 DOI: 10.3390/nu13082777] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Abstract
Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.
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Affiliation(s)
- Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
| | - Michael Livingston
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia;
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia
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19
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Askarian M, Khakpour M, Taghrir MH, Akbarialiabad H, Borazjani R. Investigating the epidemiology of methanol poisoning outbreaks: a scoping review protocol. JBI Evid Synth 2021; 19:1388-1393. [PMID: 33323771 DOI: 10.11124/jbies-20-00221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aim to identify relevant studies from 2000 to 2020 regarding methanol poisoning outbreaks and map the existing literature with a focus on the epidemiology and global burden of disease. INTRODUCTION Methanol poisoning occurs in individuals or as an outbreak. Illicit productions are responsible for most methanol poisoning outbreaks; however, there are some occupational, suicidal, and homicidal incidences as well. In methanol poisoning outbreaks, medical facilities get overwhelmed quickly. The current WHO fact sheet dates back to 2014 and there have been no updates since. Based on our preliminary search, it seems that the course of methanol outbreaks has changed. INCLUSION CRITERIA The study will include peer-reviewed articles and gray papers that focus on the epidemiology of methanol poisoning outbreaks. This review will consider all methanol poisoning outbreak victims without any limitation in geographical, social, cultural, or gender-based demographics. METHODS A three-step search strategy will be used. First, an initial search will be done in MEDLINE and Scopus to identify key terms. Those key terms will then be searched across included databases (MEDLINE, Scopus, Embase, and Web of Science) and sources for gray literature. In a third step, references and Google Scholar will be searched manually. Two reviewers will screen the titles and abstracts, then full texts for identifying inclusion criteria and data extraction. Disagreements will be resolved by a senior author. Extracted data will be tabulated and mapped. Quantitative data will be reported using descriptive numerical summary analysis.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, School of Medicine, Health Behavior Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahasti Khakpour
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Roham Borazjani
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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The antiurolithic activity of Origanum vulgare on rats treated with ethylene glycol and ammonium chloride: Possible pharmaco-biochemical and ultrastructure effects. Curr Urol 2021; 15:119-125. [PMID: 34168532 PMCID: PMC8221014 DOI: 10.1097/cu9.0000000000000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Origanum vulgare (OV) Linn is one of the conventional remedies for urolithiasis. Hence, we tested the potential antiurolithic effect of OV active extract, in order to rationalize its medicinal use. Materials and methods: The in vivo study was of male Westar rats receiving lithogenic treatment consisting of two 0.75% ethylene glycol injections with a 1 day interval and then in drinking water given for 3 weeks along with ammonium chloride (NH4Cl) from the 2nd day to the 7th day. Results: The active ethanolic extract of OV treatment (20 mg/kg) reversed toxic changes including loss of body weight gain and appetite, raised serum urea and creatinine levels, and raised blood pressure compared to controls. Conclusions: The acquired data thus suggested that OV showed antiurolithic effects against renal calcium oxalate crystal deposits by combined mechanisms acting on multiple sites through hypoxaliuric, hypocalciuric, and antioxidant effects.
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21
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Letavernier E, Daudon M. [Effect of stiripentol on urine oxalate excretion]. Nephrol Ther 2021; 17S:S95-S99. [PMID: 33910706 DOI: 10.1016/j.nephro.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 11/16/2022]
Abstract
Oxalate is a metabolite promoting the formation of calcium oxalate crystals in urine. Hyperoxaluria is a feature of genetic diseases, known as primary hyperoxaluria, leading to chronic kidney disease. Ethylene glycol poisoning induces the crystallization of calcium oxalate crystals in renal tubules, promoting acute renal failure. Urine oxalate results from glyoxylate transformation to oxalate in the liver, due to lactate dehydrogenase (LDH) activity, especially the LDH-5 isoenzyme. Genetic RNA interference therapy targeting lactate dehydrogenase lowers urine oxalate excretion in murine models. Stiripentol is a drug inhibiting neuronal LDH-5 isoenzyme activity. We hypothesized that stiripentol would also reduce hepatic oxalate production and urine oxalate excretion. In vitro Stiripentol decreases oxalate synthesis by hepatocytes. In vivo, stiripentol decreases urine oxalate excretion in rats and protects kidney tissue and function against ethylene glycol intoxication and hydroxyproline-induced calcium oxalate crystalline nephropathy. The use of stiripentol in clinical practice deserves further clinical studies.
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Affiliation(s)
- Emmanuel Letavernier
- Sorbonne Université, 4, rue de la Chine, 75020 Paris, France; Inserm, UMR S 1155 Maladies fréquentes et rares: des mécanismes moléculaires à la médecine personnalisée, 4, rue de la Chine, 75020 Paris, France; Service des explorations fonctionnelles multidisciplinaires, hôpital Tenon, 4, rue de la Chine, 75020 Paris France.
| | - Michel Daudon
- Sorbonne Université, 4, rue de la Chine, 75020 Paris, France; Inserm, UMR S 1155 Maladies fréquentes et rares: des mécanismes moléculaires à la médecine personnalisée, 4, rue de la Chine, 75020 Paris, France; Service des explorations fonctionnelles multidisciplinaires, hôpital Tenon, 4, rue de la Chine, 75020 Paris France
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22
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Bini M, Rajesh B, Babu TD. Chronic exposure of industrial grade calcium carbide and ethylene glycol alter histological architecture of systemic organs by disrupting redox balance in rat. J Basic Clin Physiol Pharmacol 2021; 33:265-271. [PMID: 33770829 DOI: 10.1515/jbcpp-2020-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The threat to human health or the surroundings by the use of artificial fruit ripening agents has become a global concern. Calcium carbide (CaC2) and ethylene glycol (EG) are the two widely using ripening agents. The present study evaluates the toxic effect of chronic exposures of CaC2 and EG in rats. METHODS CaC2 and EG were administered to the rats for 180 days orally. The alterations in oxido-reduction status, haematological, biochemical and histopathological parameters were analysed. Arsenic content in CaC2 and animal samples were detected by atomic absorption spectrometer and phosphorus by molybdate-UV method. RESULTS At chronic doses, there were no significant alterations in haematological and biochemical parameters except in creatinine level especially by EG. However, histological details revealed microvesicular fatty change in liver, corpuscles degeneration in kidney and lymphocytes infiltration in various tissues. In intestine, the mucosal lesion scoring was found high (p<0.01). SOD and CAT activities and GSH level was reduced significantly by CaC2 administration (p<0.01). Arsenic and phosphorus detected is above the toxic level: 7.222 and 13.91 mg/dL in CaC2, 1.634 and 6.22 mg/dL in blood and 0.563 and 6.99 mg/dL in liver, respectively. CONCLUSIONS The study suggests that the industrial grade CaC2 and EG induce systemic toxicity to rats and the liver is the most susceptible organ. The CaC2 and EG toxicity is mediated through the upset of redox balance and subsequent inflammatory responses. This could be due to the presence of arsenic and phosphorus contents that detected above the normal level in the industrial grade CaC2.
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Affiliation(s)
- Markose Bini
- Department of Anatomy, Bharath Institute of Higher Education and Research, Chennai, India.,Department of Anatomy, Amala Institute of Medical Sciences, Thrissur, India
| | - Bhargavan Rajesh
- Department of Anatomy, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
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23
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Thongprayoon C, Petnak T, Kaewput W, Mao MA, Boonpheng B, Bathini T, Vallabhajosyula S, Lertjitbanjong P, Qureshi F, Cheungpasitporn W. Acute kidney injury in hospitalized patients with methanol intoxication: National Inpatient Sample 2003-2014. Hosp Pract (1995) 2021; 49:203-208. [PMID: 33496631 DOI: 10.1080/21548331.2021.1882239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to 1) determine the incidence of acute kidney injury (AKI), 2) identify risk factors for AKI, and 3) evaluate the impact of AKI on in-hospital outcomes in hospitalized patients for methanol intoxication. METHODS We searched the National Inpatient Sample Database for hospitalized patients from 2003 to 2014 with a primary diagnosis of methanol intoxication. We excluded patients with end-stage kidney disease. We identified the AKI using a discharge diagnosis code. We compared clinical characteristics, in-hospital treatment, outcomes, and resource use between AKI and non-AKI patients. RESULTS A total of 603 hospital admissions for methanol intoxication were analyzed. AKI developed in 135 (22.4%) admissions. Anemia (OR 3.43 p < 0.001), hypertension (OR 1.86; p = 0.02), volume depletion (OR 3.46; p = 0.001), sepsis (OR 6.91; p < 0.001), rhabdomyolysis (OR 6.25; p = 0.003), and acute pancreatitis (OR 5.30; p = 0.004) were independent risk factors for AKI development. AKI was significantly associated with increased risk of in-hospital mortality and organ failure. AKI patients needed more mechanical ventilation, and extracorporeal therapy, had longer length of hospital stay, and higher hospitalization costs. CONCLUSION Over one-fifth of methanol intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilization.
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Affiliation(s)
- Charat Thongprayoon
- Department of Medicine, Division of Nephrology and Hypertension, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Michael A Mao
- Department of Medicine, Division of Nephrology and Hypertension, Jacksonville, FL, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fawad Qureshi
- Department of Medicine, Division of Nephrology and Hypertension, Rochester, MN, USA
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24
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Poirier-Blanchette L, Simard C, Schwartz BC. Spurious point-of-care lactate elevation in ethylene glycol intoxication: rediscovering a clinical pearl. BMJ Case Rep 2021; 14:14/2/e239936. [PMID: 33568412 PMCID: PMC7878139 DOI: 10.1136/bcr-2020-239936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 76-year-old man was found unresponsive and brought to the emergency department. Initial workup showed profound lactic acidosis on a point-of-care arterial blood gas, without clinical signs of hypoperfusion. Investigations for types A and B lactic acidosis revealed no unifying diagnosis to explain both his altered mental status and profound lactic acidosis. A toxicology workup revealed an increased osmolar gap and an elevated ethylene glycol level. The lactic acidosis and his mental status completely normalised within 8 hours of renal replacement therapy initiation and fomepizole administration. Ethylene glycol metabolites have similar molecular structure with L-lactate. Some blood gas analysers are unable to differentiate them, resulting in an artefactual lactate elevation. Our case highlights the importance of recognising a falsely elevated lactate, which should raise clinical suspicion of ethylene glycol poisoning, as the treatment is time-sensitive to prevent complications and mortality.
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Affiliation(s)
| | - Camille Simard
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Blair Carl Schwartz
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada,Division of General Internal Medicine, Jewish General Hospital, Montreal, Quebec, Canada
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25
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Abstract
PURPOSE OF REVIEW Oxalate is a metabolic end-product promoting the formation of calcium oxalate crystals in urine. Massive urine oxalate excretion occurs in genetic diseases, mainly primary hyperoxaluria type I and II, threatening renal function. Ethylene glycol poisoning may induce the precipitation of calcium oxalate crystals in renal tubules, leading to acute renal failure. In both cases, oxalate results from glyoxylate transformation to oxalate in the liver, by lactate dehydrogenase (LDH) enzymes, especially the LDH-5 isoenzyme. The purpose of the review is to highlight LDH as a potential therapeutic target according to recent publications. RECENT FINDINGS Genetic therapy targeting LDH metabolism decreases urine oxalate excretion in rodents. Stiripentol is an antiepileptic drug that has been shown recently to inhibit neuronal LDH-5 isoenzyme. Stiripentol was hypothesized to reduce hepatic oxalate production and urine oxalate excretion. In vitro, stiripentol decreases oxalate synthesis by hepatocytes. In vivo, stiripentol oral administration decreases urine oxalate excretion in rats and protects renal function and renal tissue against ethylene glycol intoxication and chronic calcium oxalate crystalline nephropathy. SUMMARY The use of stiripentol in-vitro and in-vivo highlights that targeting hepatic LDH by pharmacological or genetic tools may decrease oxalate synthesis, deserving clinical studies.
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26
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Sawminathan S, Iyer SK. A new imidazole based phenanthridine probe for ratiometric fluorescence monitoring of methanol in biodiesel. NEW J CHEM 2021. [DOI: 10.1039/d0nj06252a] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We prepared and characterized an array of polarity-sensitive fluorescent dyes (7and 9a, 9b and 9c). for detection of methanol
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Affiliation(s)
- Sathish Sawminathan
- Department of Chemistry
- School of Advanced Sciences
- Vellore Institute of Technology
- Vellore
- India
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27
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Sasanami M, Yamada T, Obara T, Nakao A, Naito H. Oral Ethanol Treatment for Ethylene Glycol Intoxication. Cureus 2020; 12:e12268. [PMID: 33510981 PMCID: PMC7827791 DOI: 10.7759/cureus.12268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.
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Affiliation(s)
- Misa Sasanami
- Center for Graduate Medical Education, Okayama University Hospital, Okayama, JPN
| | - Taihei Yamada
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Takafumi Obara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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28
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Patel R, Mistry AM, Mistry CM. Unintentional Ethylene Glycol Poisoning in an Adolescent. Cureus 2020; 12:e11521. [PMID: 33354465 PMCID: PMC7746011 DOI: 10.7759/cureus.11521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The differential diagnosis is broad when a patient presents with an altered mental status. Ethylene glycol poisoning, a life-threatening condition, can occur as an intentional self-harm attempt or unintentional consumption. It is metabolized in the liver by a series of enzymes, and the metabolites so formed are responsible for the majority of clinical effects. The diverse range of clinical effects includes central nervous system (CNS), gastrointestinal, cardiovascular system (CVS), pulmonary as well as renal effects. The evidence of metabolic acidosis, elevated anion gap, high osmolal gap, and calcium oxalate crystals in laboratory analysis strongly suggests ethylene glycol poisoning. The treatment traditionally consists of alcohol dehydrogenase inhibitors such as fomepizole or ethanol, and in some cases, hemodialysis is needed as well.
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Affiliation(s)
- Rutul Patel
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Anuja Mahesh Mistry
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (NHLMMC), Ahmedabad, IND
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29
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Abstract
Currently, apart from the widely known lithium-ion batteries, there are competitive solutions in the form of, for example, Li-S batteries. While the results of studies on the toxicity of Li-ion battery components are published, such studies on the components of Li-S cells are just beginning. The purpose of the current review was to identify materials used in the production of Li-S batteries and their toxicity, especially for humans. The review showed many kinds of materials with different levels of toxicity utilized for manufacturing of these cells. Some materials are of low toxicity, while some others are of the high one. A lot of materials have assigned different hazard statements. For some of the materials, no hazard statements were assigned, although such materials are toxic. No data related to the toxicity of some materials were found in the literature. This points out the need to further studies on their toxicity and legal actions to assign appropriate hazard statements.
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30
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Heda GD, Shrestha L, Thapa S, Ghimire S, Raut D. Optimization of western blotting for the detection of proteins of different molecular weight. Biotechniques 2020; 68:318-324. [PMID: 32283940 PMCID: PMC7333534 DOI: 10.2144/btn-2019-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Protein samples electroblotted onto nitrocellulose membranes and quenched with a mixture of blocking agents produced a strong signal for cystic fibrosis transmembrane-conductance regulator (CFTR), a high-molecular-weight protein, in western blotting. Optimized conditions for CFTR were then extended to medium- and low-molecular-weight proteins (LAMP1 and Rab11a, respectively) to determine the effects of methanol concentration (0-20%) in Towbin's transfer buffer (TTB). Methanol in TTB appears to have little to no effect on CFTR signal. However, for medium-sized (LAMP1) and small (Rab11a) proteins, a lower concentration of methanol (10%) was sufficient to produce a maximal signal. Therefore, methanol, a toxic solvent, can be removed from or reduced in TTB without compromising signal strength. Here, we show modifications that may be useful in detecting and/or improving the signal of low-abundance proteins.
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Affiliation(s)
- Ghanshyam D Heda
- Department of Sciences & Mathematics, Mississippi University for Women, Columbus, MS 39701, USA
| | - Lisa Shrestha
- Department of Sciences & Mathematics, Mississippi University for Women, Columbus, MS 39701, USA
- Molecular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Sagarina Thapa
- Department of Sciences & Mathematics, Mississippi University for Women, Columbus, MS 39701, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Shreya Ghimire
- Department of Sciences & Mathematics, Mississippi University for Women, Columbus, MS 39701, USA
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52240, USA
| | - Diptika Raut
- Department of Sciences & Mathematics, Mississippi University for Women, Columbus, MS 39701, USA
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31
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Chen J. Severe methanol intoxication with atypical symptoms and imaging changes: a fatal case report. Br J Neurosurg 2020:1-2. [DOI: 10.1080/02688697.2020.1765977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jiaqi Chen
- Department of Neurology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejing, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences., Ningbo, Zhejing, China
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32
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Shihana F, Joglekar MV, Raubenheimer J, Hardikar AA, Buckley NA, Seth D. Circulating human microRNA biomarkers of oxalic acid-induced acute kidney injury. Arch Toxicol 2020; 94:1725-1737. [PMID: 32086547 DOI: 10.1007/s00204-020-02679-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Oxalic acid-induced nephrotoxicity and acute kidney injury result from formation of calcium oxalate crystals. Oxalic acid-induced acute kidney injury is a significant problem in many parts of the world. Circulating biomarkers that can accurately and reproducibly detect acute kidney injury are highly desirable. We used a high sensitivity discovery platform to identify signature microRNAs to distinguish healthy individuals never exposed to oxalic acid (n = 4) from those who were exposed to oxalic acid but had no injury (NOAKI; n = 4), moderate injury (AKIN2; n = 4) or severe injury (AKIN3; n = 4). Longitudinal analyses identified 4-8 h post-ingestion as the best time to detect AKIN2/3. We validated a signature of 53 microRNAs identified in the discovery, in a second cohort of individuals exposed to oxalic acid (NOAKI = 11, AKIN2 = 8 and AKIN3 = 18) and healthy controls (n = 19). Thirteen microRNAs were significantly downregulated in acute kidney injury patients compared to NOAKI within 8-h post-ingestion. Five microRNAs (miR-20a, miR-92a, miR-93, miR-195, miR-451) had a highly significant correlation with normalized urinary albumin, serum creatinine at 24 h and creatinine clearance. Logistic regression of these microRNAs had AUC-ROC of 0.85 predicting AKIN2/3 and discriminated patients from healthy controls (AUC-ROC = 0.93). mRNA targets of these microRNAs identified oxidative stress pathways of nephrotoxicity in proximal tubule and glomeruli nephrotoxicity. In conclusion, the downregulation of multiple circulating microRNAs in patients correlated with the severity of oxalic acid-induced acute kidney injury. A set of microRNAs (miR-20a, miR-92a, miR-93, miR-195, miR-451) could be promising biomarkers for early detection of oxalic acid-induced acute kidney injury.
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Affiliation(s)
- Fathima Shihana
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Level 3, 1-3 Ross St (K06), Sydney, NSW, 2006, Australia. .,South Asian Clinical Toxicology of Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Mugdha V Joglekar
- Diabetes and Islet Biology Group, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jacques Raubenheimer
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Level 3, 1-3 Ross St (K06), Sydney, NSW, 2006, Australia
| | - Anandwardhan A Hardikar
- Diabetes and Islet Biology Group, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Level 3, 1-3 Ross St (K06), Sydney, NSW, 2006, Australia.,South Asian Clinical Toxicology of Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Devanshi Seth
- Discipline of Clinical Medicine and Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,The Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Sydney, NSW, Australia
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Ingale N, Konda R, Chaudhari A. Volatile organic compounds sensing by Li/Ti doped ethylene complex. ADSORPTION 2019. [DOI: 10.1007/s10450-019-00172-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pedersen DS, Bélanger P, Frykman M, Andreasen K, Goudreault D, Pedersen H, Hindersson P, Breindahl T. Ethylene glycol: Evidence of glucuronidation in vivoshown by analysis of clinical toxicology samples. Drug Test Anal 2019; 11:1094-1108. [PMID: 30845374 PMCID: PMC6767423 DOI: 10.1002/dta.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/06/2022]
Abstract
In the search for improved laboratory methods for the diagnosis of ethylene glycol poisoning, the in vivo formation of a glucuronide metabolite of ethylene glycol was hypothesized. Chemically pure standards of the β‐O‐glucuronide of ethylene glycol (EG‐GLUC) and a deuterated analog (d4‐EG‐GLUC) were synthesized. A high‐performance liquid chromatography and tandem mass spectrometry method for determination of EG‐GLUC in serum after ultrafiltration was validated. Inter‐assay precision (%RSD) was 3.9% to 15.1% and inter‐assay %bias was −2.8% to 12.2%. The measuring range was 2–100 μmol/L (0.48–24 mg/L). Specificity testing showed no endogenous amounts in routine clinical samples (n = 40). The method was used to analyze authentic, clinical serum samples (n = 31) from patients intoxicated with ethylene glycol. EG‐GLUC was quantified in 15 of these samples, with a mean concentration of 6.5 μmol/L (1.6 mg/L), ranging from 2.3 to 15.6 μmol/L (0.55 to 3.7 mg/L). In five samples, EG‐GLUC was detected below the limit of quantification (2 μmol/L) and it was below the limit of detection in 11 samples (1 μmol/L). Compared to the millimolar concentrations of ethylene glycol present in blood after intoxications and potentially available for conjugation, the concentrations of EG‐GLUC found in clinical serum samples are very low, but comparable to concentrations of ethyl glucuronide after medium dose ethanol intake. In theory, EG‐GLUC has a potential value as a biomarker for ethylene glycol intake, but the pharmacokinetic properties, in vivo/vitro stability and the biosynthetic pathways of EG‐GLUC must be further studied in a larger number of patients and other biological matrices.
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Affiliation(s)
- Daniel Sejer Pedersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical SciencesUniversity of Copenhagen Copenhagen Denmark
| | - Patrick Bélanger
- Centre de Toxicologie du Québec (CTQ)Institut National de Santé Publique du Québec (INSPQ), Québec Québec Canada
| | - Mikael Frykman
- Department of Drug Design and Pharmacology, Faculty of Health and Medical SciencesUniversity of Copenhagen Copenhagen Denmark
| | - Kirsten Andreasen
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
| | - Danielle Goudreault
- Laboratory of Specialized Biochemistry, Department of Clinical BiochemistryOptilab Montréal CHUM, building CHU Ste‐Justine, Montréal Quebec Canada
| | | | - Peter Hindersson
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
| | - Torben Breindahl
- Department of Clinical BiochemistryNorth Denmark Regional Hospital Hjørring Denmark
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Le Dudal M, Huguet L, Perez J, Vandermeersch S, Bouderlique E, Tang E, Martori C, Chemaly N, Nabbout R, Haymann JP, Frochot V, Baud L, Deschênes G, Daudon M, Letavernier E. Stiripentol protects against calcium oxalate nephrolithiasis and ethylene glycol poisoning. J Clin Invest 2019; 129:2571-2577. [PMID: 30946030 DOI: 10.1172/jci99822] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Increased urinary oxalate excretion (hyperoxaluria) promotes the formation of calcium oxalate crystals. Monogenic diseases due to hepatic enzymes deficiency result in chronic hyperoxaluria, promoting end-stage renal disease in children and young adults. Ethylene glycol poisoning also results in hyperoxaluria promoting acute renal failure and frequently death. Stiripentol is an antiepileptic drug used to treat children affected by Dravet syndrome, possibly by inhibiting neuronal lactate dehydrogenase 5 isoenzyme. As this isoenzyme is also the last step of hepatic oxalate production, we hypothesized that Stiripentol would potentially reduce hepatic oxalate production and urine oxalate excretion. In vitro, Stiripentol decreased in a dose-dependent manner the synthesis of oxalate by hepatocytes. In vivo, Stiripentol oral administration reduced significantly urine oxalate excretion in rats. Stiripentol protected kidneys against calcium oxalate crystal deposits in acute ethylene glycol intoxication and chronic calcium oxalate nephropathy models. In both models, Stiripentol improved significantly renal function. Patients affected by Dravet syndrome and treated with Stiripentol had a lower urine oxalate excretion than control patients. A young girl affected by severe type I hyperoxaluria received Stiripentol for several weeks: urine oxalate excretion decreased by two-thirds. Stiripentol is a promising potential therapy against genetic hyperoxaluria and ethylene glycol poisoning.
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Affiliation(s)
- Marine Le Dudal
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France.,Department of Pathology, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Léa Huguet
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Joëlle Perez
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Sophie Vandermeersch
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Elise Bouderlique
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Ellie Tang
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France
| | | | - Nicole Chemaly
- Pediatric Neurology Unit, Hôpital Necker, AP-HP and Paris Descartes University, Paris, France
| | - Rima Nabbout
- Pediatric Neurology Unit, Hôpital Necker, AP-HP and Paris Descartes University, Paris, France
| | - Jean-Philippe Haymann
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France.,Physiology Unit, AP-HP, Hôpital Tenon, Paris, France
| | | | - Laurent Baud
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France.,Physiology Unit, AP-HP, Hôpital Tenon, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology Unit, Hôpital Robert Debré, AP-HP and Paris Diderot University, Paris, France
| | - Michel Daudon
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France.,Physiology Unit, AP-HP, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, Paris, France.,INSERM, UMR S 1155, Paris, France.,Physiology Unit, AP-HP, Hôpital Tenon, Paris, France
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Durini S, Ilić N, Ramazanova K, Grell T, Lönnecke P, Hey‐Hawkins E. Methanol Sensing by a Luminescent Zinc(II)‐Based Metal−Organic Framework. Chempluschem 2019; 84:307-313. [DOI: 10.1002/cplu.201900109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/03/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Sara Durini
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
| | - Nebojša Ilić
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
- University of Belgrade Faculty of Technology and Metallurgy Department of Inorganic Chemical Technology Karnegijeva 4 11120 Belgrade Serbia
| | - Kyzgaldak Ramazanova
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
| | - Toni Grell
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
| | - Peter Lönnecke
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
| | - Evamarie Hey‐Hawkins
- Universität Leipzig Fakultät für Chemie und Mineralogie Institut für Anorganische Chemie Johannisallee 29 04103 Leipzig Germany
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37
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Bokor J, Danics K, Keller E, Szollosi Z. Time-dependent changes in kidney histopathology in ethylene glycol poisoning. MEDICINE, SCIENCE, AND THE LAW 2018; 58:257-260. [PMID: 30124101 DOI: 10.1177/0025802418795352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ethylene glycol (EG) may be acutely toxic following ingestion. In fatal cases, microscopic examination of urine and kidney specimens can establish a post-mortem diagnosis of EG poisoning. We describe the main renal histopathologic changes during different stages of EG poisoning, which might be helpful when dating the EG poisoning itself. A single-centre retrospective study conducted on all EG poisoning cases demonstrated that in an early stage of EG poisoning, fine dust-like crystals were deposited to the tubular cell basement membrane, followed by internalisation of calcium oxalate crystals into the epithelial cells. Later, the crystals formed larger aggregates within the epithelial cells. As the changes became advanced, pronounced tubular epithelial damage occurred, with detachment of epithelial cells from the basement membrane. In the final stage, coarse calcium oxalate crystals were recognised in the tubular lumen, with cellular debris from damaged epithelial cells. Our study shows that the time-dependent histological changes described follow the clinical stages of EG poisoning and may therefore provide a rough estimate of the time of EG ingestion before death.
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Affiliation(s)
- Janos Bokor
- Department of Forensic and Insurance Medicine, Semmelweis University, Hungary
| | - Krisztina Danics
- Department of Forensic and Insurance Medicine, Semmelweis University, Hungary
| | - Eva Keller
- Department of Forensic and Insurance Medicine, Semmelweis University, Hungary
| | - Zoltan Szollosi
- Department of Forensic and Insurance Medicine, Semmelweis University, Hungary
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38
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Rosenstein PG, Tennent-Brown BS, Hughes D. Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement. J Vet Emerg Crit Care (San Antonio) 2018. [PMID: 29533512 DOI: 10.1111/vec.12708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis. Although the most common cause of hyperlactatemia is inadequate tissue oxygen delivery, hyperlactatemia can, and does occur in the face of apparently adequate oxygen supply. At a cellular level, the pathogenesis of hyperlactatemia varies widely depending on the underlying cause. Microcirculatory dysfunction, mitochondrial dysfunction, and epinephrine-mediated stimulation of Na+ -K+ -ATPase pumps are likely important contributors to hyperlactatemia in critically ill patients. Ultimately, hyperlactatemia is a marker of altered cellular bioenergetics. CONCLUSION The etiology of hyperlactatemia is complex and multifactorial. Understanding the relevant pathophysiology is helpful when characterizing hyperlactatemia in clinical patients.
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Affiliation(s)
- Patricia G Rosenstein
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Brett S Tennent-Brown
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Dez Hughes
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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39
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Gau N, Scott MG. Fill in the Gaps: An Unresponsive 55-Year-Old Man. Clin Chem 2018; 64:1001-1004. [PMID: 29954778 DOI: 10.1373/clinchem.2017.280842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/27/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nicholas Gau
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Mitchell G Scott
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
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40
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An unusual case of suicide by methanol ingestion. Forensic Sci Int 2018; 289:e9-e14. [PMID: 29908646 DOI: 10.1016/j.forsciint.2018.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/22/2022]
Abstract
A female in her late teens purposely ingested alcohol fuel containing methanol to commit suicide, which she admitted on social media. She was found in distress by her parents and died at the hospital some hours later. Autopsy revealed swelling of the brain and edematous and congestive lungs. No other trauma or unusual findings were revealed at autopsy. Methanol was detected upon routine screening for alcohols by headspace gas chromatography with flame-ionization detection. To confirm the presence of methanol and its metabolite formic acid, a method with detection by mass spectrometry was used. Methanol and formic acid were quantitated in body fluids and tissues by headspace gas chromatography with flame-ionization detection. Formic acid was converted to isopropyl formate by reaction with isopropanol and concentrated sulfuric acid. Acetonitrile was used as the internal standard. The methanol and formic acid concentrations were analyzed in peripheral blood, heart blood, cerebrospinal fluid, liver, kidney, spleen, pancreas, lung, muscle, and fat. Successful confirmation and quantitation of methanol and formic acid, a methanol metabolite, in postmortem specimens was achieved on an uncommon case of suicide by methanol ingestion.
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41
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Prinz J, Böll B, von Bergwelt-Baildon M, Burst V, Becker JU, Carvalho-Fiel D, Shimabukuro-Vornhagen A, Kochanek M. Intoxikation nach Frostschutzmittelaufnahme. Med Klin Intensivmed Notfmed 2018; 114:159-163. [DOI: 10.1007/s00063-018-0439-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
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Algahtani H, Shirah B, Ahmad R, Abobaker H, Hmoud M. Transverse myelitis-like presentation of methanol intoxication: A case report and review of the literature. J Spinal Cord Med 2018; 41:72-76. [PMID: 27707395 PMCID: PMC5810809 DOI: 10.1080/10790268.2016.1226005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
CONTEXT Methanol is the simplest member of alcohol family. However, it is an extremely toxic substance to humans upon exposure with severe and detrimental effects that range from visual loss to death. Spinal cord involvement in methanol intoxication is a rare occurrence. FINDINGS In this article, we are reporting a case of methanol intoxication with extensive spinal cord involvement possibly due to necrosis. A literature review yielded only two cases of spinal cord involvement due to methanol intoxication. Our article is the first to discuss the spinal cord involvement specifically including interesting neuroimaging features. CONCLUSION/CLINICAL RELEVANCE We recommend performing MRI of the cervicothoracic spine in every methanol intoxication case to exclude both asymptomatic and symptomatic cases of spinal cord involvement.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia,Correspondence to: Hussein Algahtani, King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 12723, Jeddah, 21483, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raafat Ahmad
- Faculty of Medicine, Suez Canal University, Egypt
| | - Hind Abobaker
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Hmoud
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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43
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Ringler S, Gmuer R, Faber K, Bleisch J, Müggler SA. [CME: Ethylene Glycol Intoxication]. PRAXIS 2018; 107:1097-1106. [PMID: 30278847 DOI: 10.1024/1661-8157/a003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.
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Affiliation(s)
| | - Roman Gmuer
- 1 Klinik für Innere Medizin, Spital Zollikerberg
| | - Katrin Faber
- 2 Tox Info Suisse, Assoziiertes Institut der Universität Zürich
| | - Jörg Bleisch
- 3 Nephrologie- und Dialysezentrum, Spital Zollikerberg
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44
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Novel porcine model for calcium oxalate stone formation. Int Urol Nephrol 2017; 49:1751-1761. [DOI: 10.1007/s11255-017-1657-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/08/2017] [Indexed: 11/27/2022]
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45
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Affiliation(s)
- Tharwat M Aisa
- Department of Intensive Care Unit, King Fahad Hospital, Baha, Kingdom of Saudi Arabia. E-mail:
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46
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Conley M, Mojica M, Mohammed F, Chen K, Napoline JW, Pollet P, Wang J, Krishnamurthy R, Liotta CL. Reaction of glycine with glyoxylate: Competing transaminations, aldol reactions, and decarboxylations. J PHYS ORG CHEM 2017. [DOI: 10.1002/poc.3709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mark Conley
- School of Chemical and Biomolecular Engineering; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Mike Mojica
- School of Chemistry and Biochemistry; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Fiaz Mohammed
- School of Chemical and Biomolecular Engineering; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Ke Chen
- School of Chemistry and Biochemistry; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Jonathan W. Napoline
- School of Chemistry and Biochemistry; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Pamela Pollet
- School of Chemistry and Biochemistry; Georgia Institute of Technology; Atlanta GA 30332 USA
| | - Jing Wang
- Department of Chemistry and Biochemistry; Jackson State University; Jackson MS 39217 USA
| | | | - Charles L. Liotta
- School of Chemistry and Biochemistry; Georgia Institute of Technology; Atlanta GA 30332 USA
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Case Report Demonstrating the Safe and Effective Means of Expanding the Donor Pool With Livers Recovered From Brain-Dead Donors After Ethylene Glycol Toxicity. Transplant Proc 2016; 48:3064-3066. [PMID: 27932147 DOI: 10.1016/j.transproceed.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022]
Abstract
The growing disparity between organ supply and demand has become the greatest hurdle facing transplant professionals and life-saving transplants. Because the organ shortage has become the rate-limiting step to effective transplants, it is critical for the transplant community to identify viable mechanisms to expand the donor pool and use every available allograft. Although using kidneys from deceased donors whose demise was secondary to ethylene glycol (EG) toxicity requires great deliberation and precise timing as described by Barbas et al [5], using hepatic allografts in this setting involves far less risk. The following is a discussion of a 61-year-old male who was diagnosed with end-stage liver disease secondary to non-alcoholic steatohepatitis and ultimately underwent a life-saving transplant with a liver recovered from a donor with EG-induced brain death and allocated nationally due to trepidation by local and regional centers to use the liver from a donor after EG toxicity.
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48
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Ethylene Glycol Poisoning: An Unusual Cause of Altered Mental Status and the Lessons Learned from Management of the Disease in the Acute Setting. Case Rep Crit Care 2016; 2016:9157393. [PMID: 27847651 PMCID: PMC5099479 DOI: 10.1155/2016/9157393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022] Open
Abstract
Ethylene glycol is found in many household products and is a common toxic ingestion. Acute ingestions present with altered sensorium and an osmolal gap. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. Early intervention is key; however, diagnosis is often delayed, especially in elderly patients presenting with altered mental status. There are several laboratory tests which can be exploited for the diagnosis, quantification of ingestion, and monitoring of treatment, including the lactate and osmolal gaps. As methods of direct measurement of ethylene glycol are often not readily available, it is important to have a high degree of suspicion based on these indirect laboratory findings. Mainstay of treatment is bicarbonate, fomepizole or ethanol, and, often, hemodialysis. A validated equation can be used to estimate necessary duration of hemodialysis, and even if direct measurements of ethylene glycol are not available, monitoring for the closure of the anion, lactate, and osmolal gaps can guide treatment. We present the case of an elderly male with altered mental status, acute kidney injury, elevated anion gap metabolic acidosis, and profound lactate and osmolal gaps.
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Adolescent Presents With Altered Mental Status and Elevated Anion Gap After Suicide Attempt by Ethylene Glycol Ingestion. Pediatr Emerg Care 2016; 32:688-690. [PMID: 26785093 DOI: 10.1097/pec.0000000000000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 16-year-old healthy adolescent male who presented to the local emergency department with altered mental status. En route to a tertiary care facility, he began to decompensate and was found to be markedly acidotic. Further investigation revealed an elevated anion gap, and physical examination showed only abdominal pain and decreased level of consciousness. A broad differential diagnosis was considered at the time of the patient's presentation at the tertiary care center including ingestion of a volatile alcohol, sepsis, and an abdominal catastrophe. Although fomepizole and emergent dialysis were being initiated, laboratory tests confirmed ethylene glycol poisoning. This case demonstrates the importance of early recognition of potential ingestions in patients with altered mental status and supportive laboratory findings.
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50
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Inherited or acquired metabolic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016. [PMID: 27432685 DOI: 10.1016/b978-0-444-53485-9.00029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This chapter starts with a description of imaging of inherited metabolic disorders, followed by a discussion on imaging of acquired toxic-metabolic disorders of the adult brain. Neuroimaging is crucial for the diagnosis and management of a number of inherited metabolic disorders. Among these, inherited white-matter disorders commonly affect both the nervous system and endocrine organs. Magnetic resonance imaging (MRI) has enabled new classifications of these disorders that have greatly enhanced both our diagnostic ability and our understanding of these complex disorders. Beyond the classic leukodystrophies, we are increasingly recognizing new hereditary leukoencephalopathies such as the hypomyelinating disorders. Conventional imaging can be unrevealing in some metabolic disorders, but proton magnetic resonance spectroscopy (MRS) may be able to directly visualize the metabolic abnormality in certain disorders. Hence, neuroimaging can enhance our understanding of pathogenesis, even in the absence of a pathologic specimen. This review aims to present pathognomonic brain MRI lesion patterns, the diagnostic capacity of proton MRS, and information from clinical and laboratory testing that can aid diagnosis. We demonstrate that applying an advanced neuroimaging approach enhances current diagnostics and management. Additional information on inherited and metabolic disorders of the brain can be found in Chapter 63 in the second volume of this series.
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