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AlSamh DA, Kramer AH. Neurologic Complications in Critically Ill Patients with Toxic Alcohol Poisoning: A Multicenter Population-Based Cohort Study. Neurocrit Care 2024; 40:734-742. [PMID: 37697128 DOI: 10.1007/s12028-023-01821-2] [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: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Toxic alcohol poisoning is regularly encountered in emergency departments and intensive care units (ICUs). Most patients present with an altered level of consciousness, but the subsequent course and spectrum of neurologic complications and outcomes is highly variable. METHODS We performed a population-based, multicenter retrospective cohort study of critically ill patients with toxic alcohol poisoning admitted to ICUs in Alberta, Canada, between 2007 and 2019 to describe neurologic sequelae, including seizures, coma, neuroimaging abnormalities, persistent cognitive or visual impairment, and mortality. Multivariate analysis was performed to identify predictors of poor outcome. RESULTS We identified 104 patients, including 55 (53%) with methanol ingestion, 36 (35%) with ethylene glycol ingestion, and 13 (13%) with isopropanol ingestion. In patients who underwent neuroimaging, abnormalities were detected in 9 of 24 (38%) with methanol toxicity, 5 of 20 (25%) with ethylene glycol toxicity, and 0 of 10 with isopropanol toxicity (p = 0.07). Basal ganglia were commonly involved with both methanol and ethylene glycol poisoning, but prominent subcortical involvement and restricted diffusion were observed only with methanol poisoning. The composite of death, persistent cognitive impairment, or visual loss occurred in 13 (24%) patients with methanol poisoning, compared with one (3%) with ethylene glycol poisoning and none with isopropanol poisoning (p = 0.006). Among patients with methanol toxicity, greater elevation of the anion gap and lower Glasgow Coma Scale score were independent predictors of poor outcome. No patient with an anion gap ≥ 28 at presentation had a favorable recovery. Progression to death by neurologic criteria occurred in 3 of 55 (5%) patients with methanol poisoning and in none with other toxic alcohols. CONCLUSIONS Methanol overdose is the most common form of toxic alcohol poisoning to result in ICU admission. Poor neurologic outcomes may occur especially with methanol poisoning, with more than one in five patients dying or having persistent cognitive or visual impairment. A wide anion gap independently predicts poor outcome, emphasizing the importance of expeditious recognition and treatment.
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Affiliation(s)
- Danah Abo AlSamh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, McCaig Tower, Foothills Medical Center, University of Calgary, 3134 Hospital Drive NW Calgary, Calgary, AB, T2N 2T9, Canada.
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Matar AJ, Magliocca JF, Kitchens WH. Successful Liver Transplantation from a Deceased Donor After Ethylene Glycol Ingestion: A Case Report and Review of the Literature of Organ Donation from Poisoned Donors. Transplant Proc 2022; 54:128-134. [PMID: 34972567 DOI: 10.1016/j.transproceed.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
Despite the increase in deceased organ donation over the past ten years, the gap between patients awaiting transplant and available organs continues to widen. Deceased donors secondary to acute fatal poisonings represent less than 1% of all organ donors. Organs from poisoned donors have largely been discarded due to concerns of toxin transmission and poor organ function as well as the paucity of data that exists regarding this donor population. Here, we report a case of a 40-year-old male who underwent successful liver re-transplantation from a donor who died following ethylene glycol ingestion. To our knowledge this case report is the first to describe successful re-transplantation from an ethylene glycol-poisoned donor. We also provide a comprehensive review of the literature describing organ donation from poisoned donors.
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Affiliation(s)
- Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Sklienka P, Neiser J, Ševčík P, Dvořáček I, Samlík J, Jonszta T, Dedek V, Kubišová MM, Tomanová R, Streitová D. Successful Kidney Transplant from Methanol-Intoxicated Donors. Prog Transplant 2014; 24:199-205. [DOI: 10.7182/pit2014111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The well-described disparity between the need for and the supply of organs suitable for transplant is growing. Because of this disparity, mortality of patients listed for transplant is increasing. Donors who die of intoxication (including victims of methanol poisoning) represent less than 1% of suitable donors and might be used to increase the supply of organs. They are often not accepted as donors by transplant specialists, because of concerns about patients' outcomes with these grafts. Three cases of fatal methanol intoxication that resulted in transplants of 6 kidneys are evaluated.
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Affiliation(s)
- Peter Sklienka
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Jan Neiser
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Pavel Ševčík
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Igor Dvořáček
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Jiří Samlík
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Tomáš Jonszta
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Vladimír Dedek
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Michaela Matyskov Kubišová
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Radoslava Tomanová
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
| | - Dana Streitová
- University Hospital Ostrava (PS, JN, PŠ, ID, JS, TJ, DS, RT), University of Ostrava (VD), Ostrava, Czech Republic, Charles University, Hradec Králové, Czech Republic (MMK)
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