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Yoshioka T, Koyanagi M, Yoshida N. Real-world safety and effectiveness of intravenous fomepizole in patients with ethylene glycol and methanol poisoning in Japan: results of a 7-year post-marketing surveillance study. Expert Opin Drug Saf 2024:1-9. [PMID: 38932699 DOI: 10.1080/14740338.2024.2372410] [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: 12/21/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Fomepizole is a competitive alcohol dehydrogenase inhibitor used for the treatment of ethylene glycol and methanol poisoning. We evaluated the safety and effectiveness of fomepizole in patients with ethylene glycol or methanol poisoning in Japan. RESEARCH DESIGN AND METHODS This retrospective post-marketing surveillance study conducted in Japan registered patients who received fomepizole intravenous infusion per the package insert (January 2015-June 2022). Endpoints included adverse drug reactions/infections (ADRs), arterial blood pH, and treatment outcomes. RESULTS Of 147 patients registered (91 institutions), 131 and 126 were included in the safety and effectiveness analysis sets, respectively. Mean age was 43.6 years, and 66.4% were male. Mean time from poison ingestion to treatment was 15.1 hours; 66.4% received concomitant hemodialysis. No serious ADRs were reported. ADRs were reported in seven patients; the most-reported ADR was vomiting (2.3%). Seven patients died, 105 survived without sequelae, and 19 survived with sequelae. Most common sequelae were renal failure or renal dysfunction. Mean arterial blood pH increased to 7.4 by 4 hours of treatment, remaining stable for 24 hours post-treatment. CONCLUSIONS Fomepizole is well tolerated and helps improve clinical outcomes in patients with ethylene glycol or methanol poisoning in Japan. TRIAL REGISTRATION Japanese Pharmaceutical Information Center (JapicCTI-152817).
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Affiliation(s)
- Toshiharu Yoshioka
- Vice-President, Morinomiya University of Medical Sciences, Osaka, Japan
- Representative Director, Japan Poison Information Center, Osaka, Japan
| | - Momoha Koyanagi
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Naoki Yoshida
- Statistical and Quantitative Sciences, Data Sciences Institute, Research & Development, Takeda Pharmaceutical Company Limited, Osaka, Japan
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Deville K, Charlton N, Askenazi D. Use of extracorporeal therapies to treat life-threatening intoxications. Pediatr Nephrol 2024; 39:105-113. [PMID: 36988694 DOI: 10.1007/s00467-023-05937-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
Toxic ingestions are a significant cause of pediatric morbidity and mortality, with some requiring extracorporeal removal for therapy. Given the emergent and life-threatening nature of such scenarios, it is paramount that clinicians caring for intoxicated children be familiar with the subject. This review summarizes the following: (a) the properties of a substance which lend it amenable to removal; (b) the current extracorporeal treatment modalities available for such removal (of which hemodialysis is typically the ideal choice); (c) an introduction and framework to use a quick reference guide from the Extrip organization, which has a website available to guide clinicians' rapid decisions; and (d) new membranes/approaches that may optimize clearance of certain intoxications.
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Affiliation(s)
- Kyle Deville
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, 1600 5Th Ave S, Park Place Suite 202, Birmingham, AL, 35233, USA
| | - Nathan Charlton
- Department of Emergency Medicine, Division of Toxicology, University of Virginia, Charlottesville, USA
| | - David Askenazi
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, 1600 5Th Ave S, Park Place Suite 202, Birmingham, AL, 35233, USA.
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3
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Lulić D, Gornik I, Pavičić Šarić J, Mirić M, Lukić A, Lulić I. Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report. Croat Med J 2023; 64:436-439. [PMID: 38168525 PMCID: PMC10797234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Late obstetric ethylene glycol intoxication represents a diagnostic challenge for acute care physicians and an impending life threat with life-long implications for both the mother and the fetus. The metabolism of ethylene glycol to its toxic metabolites during late pregnancy is unpredictable due to maternal physiological changes. Namely, the hallmark signs and symptoms of ethylene glycol intoxication can mimic those of late pregnancy-related high blood pressure disorders, which makes it difficult to correctly diagnose the condition. Therefore, it is crucial to promptly recognize late obstetric ethylene glycol intoxication and initiate specific treatment, but evidence-based recommendations are not available to guide its most effective emergent treatment. We present our department's emergent management of late-obstetric ethylene glycol intoxication. The parturient was stabilized by inhibiting ethylene glycol metabolism, alongside general supportive care measures. The enhancement of its toxic metabolites was eliminated by administering ethanol via the enteral route, which progressively improved the parturient's clinical course and led to the on-term delivery of a healthy child. Our case shows the importance of a meticulous emergent assessment, prompt diagnosis, and carefully planned multidisciplinary treatment in the emergency department in improving outcomes after ethylene glycol intoxication in late pregnancy.
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Affiliation(s)
- Dinka Lulić
- Dinka Lulić, Department of Emergency Medicine, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia,
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Sadeghi M, Fakhar M, Hoseininejad SM, Zakariaei Z, Sadeghi A. The clinico-epidemiological, diagnostic and therapeutic aspects of methanol poisoning: A five-year retrospective study, northern Iran. Drug Alcohol Depend 2023; 253:111024. [PMID: 38006673 DOI: 10.1016/j.drugalcdep.2023.111024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Methanol poisoning (MP) is a serious health issue that has become more prevalent in recent years and has resulted in numerous deaths. Early detection and timely treatment are critical for preventing fatalities and reducing the incidence of neurological complications. PATIENTS AND METHODS This study was designed as a retrospective investigation with the purpose of analyzing the clinico-epidemiological, diagnostic, and therapeutic aspects of patients who were admitted to two training hospitals in northern Iran due to MP. The selection of samples for this study was based on a pre-defined checklist. Following the completion of the treatment period in the hospital, the patients were categorized into three groups based on their clinical outcome. All relevant variables for each group were recorded and reported separately, using the SciPy library in the Python programming language. RESULTS The majority of the patients (88.12%) were male (P=0.012), the average age was 41.46, and mostly (82.18%) lived in urban regions (P=0.025). The primary clinical complaint reported was visual disorders, accounting for 75.25% of the cases, followed by nervous, gastrointestinal, respiratory, and chest pain accordingly. The average hospitalization length for the patients was 5.065 days. Out of the 101 patients, 65 (64.36%) were discharged without any complications, 17 (16.83%) were discharged with complications, and unfortunately, 19 (18.81%) were died. CONCLUSION A decreased level of consciousness and severe metabolic acidosis are commonly associated with unfavorable outcomes in MP. The use of systemic corticosteroids as a treatment method has a significant association with reducing mortality rates.
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Affiliation(s)
- Mahdieh Sadeghi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Zakaria Zakariaei
- Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Antimicrobial Resistance Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Alireza Sadeghi
- Intelligent Mobile Robot Lab (IMRL), Department of Mechatronics Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
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Etemadi Y, Akakpo JY, Ramachandran A, Jaeschke H. Nrf2 as a therapeutic target in acetaminophen hepatotoxicity: A case study with sulforaphane. J Biochem Mol Toxicol 2023; 37:e23505. [PMID: 37598316 PMCID: PMC10842847 DOI: 10.1002/jbt.23505] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
Acetaminophen (APAP) overdose can cause severe liver injury and acute liver failure. The only clinically approved antidote, N-acetylcysteine (NAC), is highly effective but has a narrow therapeutic window. In the last 2 decades, activation of the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2), which regulates acute phase proteins and antioxidant defense genes, has emerged as a putative new therapeutic target against APAP hepatotoxicity. However, virtually all studies that propose Nrf2 activation as mechanism of protection used prolonged pretreatment, which is not a clinically feasible approach to treat a drug overdose. Therefore, the objective of this study was to assess if therapeutic activation of Nrf2 is a viable approach to treat liver injury after APAP overdose. We used the water-soluble Nrf2 activator sulforaphane (SFN; 5 mg/kg) in a murine model of APAP hepatotoxicity (300 mg/kg). Our results indicate that short-term treatment (≤3 h) with SFN alone did not activate Nrf2 or its target genes. However, posttreatment with SFN after APAP partially protected at 6 h likely due to more rapid activation of the Nrf2-target gene heme oxygenase-1. A direct comparison of SFN with NAC given at 1 h after APAP showed a superior protection with NAC, which was maintained at 24 h unlike with SFN. Thus, Nrf2 activators have inherent problems like the need to create a cellular stress to activate Nrf2 and delayed adaptive responses which may hamper sustained protection against APAP hepatotoxicity. Thus, compared to the more direct acting antidote NAC, Nrf2 activators are less suitable for this indication.
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Affiliation(s)
- Yasaman Etemadi
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jephte Y Akakpo
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anup Ramachandran
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hartmut Jaeschke
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
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Alam MA. Pyrazole: an emerging privileged scaffold in drug discovery. Future Med Chem 2023; 15:2011-2023. [PMID: 37933613 PMCID: PMC10652296 DOI: 10.4155/fmc-2023-0207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023] Open
Abstract
Pyrazole or 1H-pyrazole, a five-membered 1,2-diazole, is found in several approved drugs and some bioactive natural products. A myriad number of derivatives of this small molecule have been reported in clinical and preclinical studies for the potential treatment of several diseases. The number of drugs containing a pyrazole nucleus has increased significantly in the last 10 years. Some of the best-selling drugs in this class are ibrutinib, ruxolitinib, axitinib, niraparib and baricitinib, and are used to treat different types of cancers; lenacapavir to treat HIV; riociguat to treat pulmonary hypertension; and sildenafil to treat erectile dysfunction. Several aniline-derived pyrazole compounds have been reported as potent antibacterial agents with selective activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Here, we discuss the pyrazole-derived drugs reported up to September 2023.
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Affiliation(s)
- Mohammad Abrar Alam
- Department of Chemistry & Physics, College of Sciences & Mathematics, Arkansas State University Jonesboro, Jonesboro, AR 72467, USA
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Filip AB, Farnsworth CW, Mullins ME, Crews BO, Kraut JA. Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection. J Med Toxicol 2023; 19:362-367. [PMID: 37695470 PMCID: PMC10522546 DOI: 10.1007/s13181-023-00967-x] [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: 04/28/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG. METHODS This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay. RESULTS Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were "positive." At the manufacturer's threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7-100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of -5.3 (-8.9 to -1.7). CONCLUSIONS The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.
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Affiliation(s)
- Ari B Filip
- Arkansas Poison and Drug Information Center, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA.
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bridgit O Crews
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey A Kraut
- Medical and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA; UCLA Membrane Biology Laboratory, Division of Nephrology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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de Maissin H, Groß PR, Mohiuddin O, Weigt M, Nagel L, Herzog M, Wang Z, Willing R, Reichardt W, Pichotka M, Heß L, Reinheckel T, Jessen HJ, Zeiser R, Bock M, von Elverfeldt D, Zaitsev M, Korchak S, Glöggler S, Hövener JB, Chekmenev EY, Schilling F, Knecht S, Schmidt AB. In Vivo Metabolic Imaging of [1- 13 C]Pyruvate-d 3 Hyperpolarized By Reversible Exchange With Parahydrogen. Angew Chem Int Ed Engl 2023; 62:e202306654. [PMID: 37439488 DOI: 10.1002/anie.202306654] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
Metabolic magnetic resonance imaging (MRI) using hyperpolarized (HP) pyruvate is becoming a non-invasive technique for diagnosing, staging, and monitoring response to treatment in cancer and other diseases. The clinically established method for producing HP pyruvate, dissolution dynamic nuclear polarization, however, is rather complex and slow. Signal Amplification By Reversible Exchange (SABRE) is an ultra-fast and low-cost method based on fast chemical exchange. Here, for the first time, we demonstrate not only in vivo utility, but also metabolic MRI with SABRE. We present a novel routine to produce aqueous HP [1-13 C]pyruvate-d3 for injection in 6 minutes. The injected solution was sterile, non-toxic, pH neutral and contained ≈30 mM [1-13 C]pyruvate-d3 polarized to ≈11 % (residual 250 mM methanol and 20 μM catalyst). It was obtained by rapid solvent evaporation and metal filtering, which we detail in this manuscript. This achievement makes HP pyruvate MRI available to a wide biomedical community for fast metabolic imaging of living organisms.
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Affiliation(s)
- Henri de Maissin
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Philipp R Groß
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Obaid Mohiuddin
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Moritz Weigt
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Luca Nagel
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marvin Herzog
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Zirun Wang
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Robert Willing
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Wilfried Reichardt
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Martin Pichotka
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Lisa Heß
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 17, 79104, Freiburg, Germany
| | - Thomas Reinheckel
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 17, 79104, Freiburg, Germany
| | - Henning J Jessen
- Bioorganic Chemistry, Institute of Organic Chemistry, Albert-Ludwigs-University of Freiburg, Albertstrasse 21, 79104, Freiburg, Germany
| | - Robert Zeiser
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Hematology and Oncology, Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Dominik von Elverfeldt
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Maxim Zaitsev
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
| | - Sergey Korchak
- NMR Signal Enhancement Group, Max Planck Institute for Multidisciplinary Sciences, Am Fassberg 11, 37077, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration of the University Medical Center Göttingen, Von-Siebold-Str. 3 A, 37075, Göttigen, Germany
| | - Stefan Glöggler
- NMR Signal Enhancement Group, Max Planck Institute for Multidisciplinary Sciences, Am Fassberg 11, 37077, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration of the University Medical Center Göttingen, Von-Siebold-Str. 3 A, 37075, Göttigen, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging SBMI, Molecular Imaging North Competence Center MOINCC, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel University, 24105, Kiel, Germany
| | - Eduard Y Chekmenev
- Department of Chemistry, Integrative Biosciences (Ibio), Karmanos CancerInstitute (KCI), Wayne State University, Detroit, MI 48202, USA
| | - Franz Schilling
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | | | - Andreas B Schmidt
- Division of Medical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Chemistry, Integrative Biosciences (Ibio), Karmanos CancerInstitute (KCI), Wayne State University, Detroit, MI 48202, USA
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Jangjou A, Moqadas M, Mohsenian L, Kamyab H, Chelliapan S, Alshehery S, Ali MA, Dehbozorgi F, Yadav KK, Khorami M, Zarei Jelyani N. Awareness raising and dealing with methanol poisoning based on effective strategies. ENVIRONMENTAL RESEARCH 2023; 228:115886. [PMID: 37072082 DOI: 10.1016/j.envres.2023.115886] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
Intoxication with methanol most commonly occurs as a consequence of ingesting, inhaling, or coming into contact with formulations that include methanol as a base. Clinical manifestations of methanol poisoning include suppression of the central nervous system, gastrointestinal symptoms, and decompensated metabolic acidosis, which is associated with impaired vision and either early or late blindness within 0.5-4 h after ingestion. After ingestion, methanol concentrations in the blood that are greater than 50 mg/dl should raise some concern. Ingested methanol is typically digested by alcohol dehydrogenase (ADH), and it is subsequently redistributed to the body's water to attain a volume distribution that is about equivalent to 0.77 L/kg. Moreover, it is removed from the body as its natural, unchanged parent molecules. Due to the fact that methanol poisoning is relatively uncommon but frequently involves a large number of victims at the same time, this type of incident occupies a special position in the field of clinical toxicology. The beginning of the COVID-19 pandemic has resulted in an increase in erroneous assumptions regarding the preventative capability of methanol in comparison to viral infection. More than 1000 Iranians fell ill, and more than 300 of them passed away in March of this year after they consumed methanol in the expectation that it would protect them from a new coronavirus. The Atlanta epidemic, which involved 323 individuals and resulted in the deaths of 41, is one example of mass poisoning. Another example is the Kristiansand outbreak, which involved 70 people and resulted in the deaths of three. In 2003, the AAPCC received reports of more than one thousand pediatric exposures. Since methanol poisoning is associated with high mortality rates, it is vital that the condition be addressed seriously and managed as quickly as feasible. The objective of this review was to raise awareness about the mechanism and metabolism of methanol toxicity, the introduction of therapeutic interventions such as gastrointestinal decontamination and methanol metabolism inhibition, the correction of metabolic disturbances, and the establishment of novel diagnostic/screening nanoparticle-based strategies for methanol poisoning such as the discovery of ADH inhibitors as well as the detection of the adulteration of alcoholic drinks by nanoparticles in order to prevent methanol poisoning. In conclusion, increasing warnings and knowledge about clinical manifestations, medical interventions, and novel strategies for methanol poisoning probably results in a decrease in the death load.
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Affiliation(s)
- Ali Jangjou
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Moqadas
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Mohsenian
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hesam Kamyab
- Faculty of Architecture and Urbanism, UTE University, Calle Rumipamba S/N and Bourgeois, Quito, Ecuador; Department of Biomaterials, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, 600 077, India; Process Systems Engineering Centre (PROSPECT), Faculty of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai, Johor, Malaysia.
| | - Shreeshivadasan Chelliapan
- Engineering Department, Razak Faculty of Technology and Informatics, Universiti Teknologi Malaysia, Jln Sultan Yahya Petra, 54100, Kuala Lumpur, Malaysia.
| | - Sultan Alshehery
- Department of Mechanical Engineering King Khalid University, zip code - 62217, Saudi Arabia
| | - Mohammed Azam Ali
- Department of Mechanical Engineering King Khalid University, zip code - 62217, Saudi Arabia
| | - Farbod Dehbozorgi
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Krishna Kumar Yadav
- Faculty of Science and Technology, Madhyanchal Professional University, Ratibad, Bhopal, 462044, India; Environmental and Atmospheric Sciences Research Group, Scientific Research Center, Al-Ayen University, Thi-Qar, Nasiriyah, 64001, Iraq
| | - Masoud Khorami
- Department of Civil Engineering, Islamic Azad University, Central Tehran Branch, Tehran, Iran
| | - Najmeh Zarei Jelyani
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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10
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Wu S, Zhu L, Ye Q, Zhu Y, Zhang T, Chen X, Zhong W. Mechanisms for the structural dependent transformation of 6:2 and 8:2 polyfluoroalkyl phosphate diesters in wheat (Triticum aestivum L.). JOURNAL OF HAZARDOUS MATERIALS 2023; 454:131536. [PMID: 37146340 DOI: 10.1016/j.jhazmat.2023.131536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/25/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
Polyfluoroalkyl phosphate esters (PAPs) are widely used and detected in various environmental media and organisms, but little is known about their behaviors in plants. In this study, the uptake, translocation and transformation of 6:2 and 8:2 diPAP in wheat using hydroponic experiments were investigated. 6:2 diPAP was more easily taken up by roots and translocated to shoots than 8:2 diPAP. Their phase I metabolites were fluorotelomer saturated carboxylates (FTCAs), fluorotelomer unsaturated carboxylates (FTUCAs) and perfluoroalkyl carboxylic acids (PFCAs). PFCAs with even-numbered chain length were the primary phase I terminal metabolites suggesting that they were mainly generated through β-oxidation. Cysteine and sulfate conjugates were the primary phase II transformation metabolites. The higher levels and ratios of phase II metabolites in the 6:2 diPAP exposure group indicated that the phase I metabolites of 6:2 diPAP were more susceptible to phase II transformation than that of 8:2 diPAP, which was confirmed by density functional theory calculation. Enzyme activity analyses and in vitro experiments demonstrated that cytochrome P450 and alcohol dehydrogenase actively participated in the phase Ⅰ transformation of diPAPs. Gene expression analyses showed that glutathione S-transferase (GST) was involved in the phase Ⅱ transformation, and the subfamily GSTU2 played a dominant role.
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Affiliation(s)
- Sihan Wu
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Lingyan Zhu
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Qingqing Ye
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Yumin Zhu
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Tianxu Zhang
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Xin Chen
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China
| | - Wenjue Zhong
- Key Laboratory of Pollution Processes and Environmental Criteria (Ministry of Education), Tianjin Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin 300350, PR China.
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11
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Im H, Pearson ML, Martinez E, Cichos KH, Song X, Kruckow KL, Andrews RM, Ghanem ES, Orihuela CJ. Targeting NAD+ regeneration enhances antibiotic susceptibility of Streptococcus pneumoniae during invasive disease. PLoS Biol 2023; 21:e3002020. [PMID: 36928033 PMCID: PMC10019625 DOI: 10.1371/journal.pbio.3002020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/02/2023] [Indexed: 03/18/2023] Open
Abstract
Anaerobic bacteria are responsible for half of all pulmonary infections. One such pathogen is Streptococcus pneumoniae (Spn), a leading cause of community-acquired pneumonia, bacteremia/sepsis, and meningitis. Using a panel of isogenic mutants deficient in lactate, acetyl-CoA, and ethanol fermentation, as well as pharmacological inhibition, we observed that NAD(H) redox balance during fermentation was vital for Spn energy generation, capsule production, and in vivo fitness. Redox balance disruption in fermentation pathway-specific fashion substantially enhanced susceptibility to killing in antimicrobial class-specific manner. Blocking of alcohol dehydrogenase activity with 4-methylpyrazole (fomepizole), an FDA-approved drug used as an antidote for toxic alcohol ingestion, enhanced susceptibility of multidrug-resistant Spn to erythromycin and reduced bacterial burden in the lungs of mice with pneumonia and prevented the development of invasive disease. Our results indicate fermentation enzymes are de novo targets for antibiotic development and a novel strategy to combat multidrug-resistant pathogens.
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Affiliation(s)
- Hansol Im
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Madison L. Pearson
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Eriel Martinez
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kyle H. Cichos
- Department of Orthopaedic Surgery Arthroplasty Section, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Xiuhong Song
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Katherine L. Kruckow
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel M. Andrews
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Elie S. Ghanem
- Department of Orthopaedic Surgery Arthroplasty Section, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Carlos J. Orihuela
- Department of Microbiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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12
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Filip AB, Mullins ME. Fomepizole should be used more liberally in paracetamol overdose. Br J Clin Pharmacol 2023; 89:594-598. [PMID: 36471569 DOI: 10.1111/bcp.15594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Growing clinical and basic science data support the use of fomepizole as an adjunct to N-acetylcysteine in paracetamol poisoning. This safe antidote may be helpful in severely poisoned patients.
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Affiliation(s)
- Ari B Filip
- Arkansas Poison and Drug Information Center, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas, USA
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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13
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Stanton MT. Part
II
: Interactive case: Toxicology and poison control. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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ŞAHİN T, BOL O, ALTUNTAŞ M. Acil Servise Başvuran Metil Alkol Zehirlenmelerinin Geriye Dönük Analizi. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1147742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Methyl alcohol poisoning remains a significant cause of mortality and morbidity. This poisoning is still one of the important reasons for admission to emergency services. We aimed to examine the admission complaints, laboratory findings, treatment methods, clinical outcomes and examine the factors affecting the mortality of patients diagnosed with methyl alcohol poisoning in the emergency department.
Methods: In this retrospective descriptive study, we analysed the patients who were considered to be diagnosed with methyl alcohol intoxication among those who came to our emergency department due to alcohol intoxication from June 1, 2018 to June 1, 2020.
Results: The study included 20 (4.86%) individuals with methyl alcohol poisoning among 411 people who presented to the emergency department due to ethyl and methyl alcohol intake and resulting effects.The mean age of the patients was 47.35±14.2 years and 85% (n=17/20) were male. Upon reviewing the patients' admission symptoms, 70% were observed to have visual problems, 60% complaints of vomiting, 45% shortness of breath, and 40% changes in consciousness. In the study, it was revealed that 18.2%(n=2/11) females and 81.8%(n=9/11) males died, and the mortality rate was calculated as 55%(n=11/20).
Conclusions: The presence of visual problems, hypotension, and coma in clinical findings, high anion gap metabolic acidosis, marked osmolar gap, an increase in lactate level, and hyperglycemia in laboratory findings may be the early signs of mortality in patients with methyl alcohol poisoning. Therefore, patients with these signs should be followed up more closely and treated.
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Affiliation(s)
- Taner ŞAHİN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, KAYSERİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Oğuzhan BOL
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, KAYSERİ ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| | - Mükerrem ALTUNTAŞ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, KAYSERİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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15
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Akakpo JY, Ramachandran A, Curry SC, Rumack BH, Jaeschke H. Comparing N-acetylcysteine and 4-methylpyrazole as antidotes for acetaminophen overdose. Arch Toxicol 2022; 96:453-465. [PMID: 34978586 PMCID: PMC8837711 DOI: 10.1007/s00204-021-03211-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
Acetaminophen (APAP) overdose can cause hepatotoxicity and even liver failure. N-acetylcysteine (NAC) is still the only FDA-approved antidote against APAP overdose 40 years after its introduction. The standard oral or intravenous dosing regimen of NAC is highly effective for patients with moderate overdoses who present within 8 h of APAP ingestion. However, for late-presenting patients or after ingestion of very large overdoses, the efficacy of NAC is diminished. Thus, additional antidotes with an extended therapeutic window may be needed for these patients. Fomepizole (4-methylpyrazole), a clinically approved antidote against methanol and ethylene glycol poisoning, recently emerged as a promising candidate. In animal studies, fomepizole effectively prevented APAP-induced liver injury by inhibiting Cyp2E1 when treated early, and by inhibiting c-jun N-terminal kinase (JNK) and oxidant stress when treated after the metabolism phase. In addition, fomepizole treatment, unlike NAC, prevented APAP-induced kidney damage and promoted hepatic regeneration in mice. These mechanisms of protection (inhibition of Cyp2E1 and JNK) and an extended efficacy compared to NAC could be verified in primary human hepatocytes. Furthermore, the formation of oxidative metabolites was eliminated in healthy volunteers using the established treatment protocol for fomepizole in toxic alcohol and ethylene glycol poisoning. These mechanistic findings, together with the excellent safety profile after methanol and ethylene glycol poisoning and after an APAP overdose, suggest that fomepizole may be a promising antidote against APAP overdose that could be useful as adjunct treatment to NAC. Clinical trials to support this hypothesis are warranted.
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Affiliation(s)
- Jephte Y. Akakpo
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anup Ramachandran
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Steven C. Curry
- Division of Clinical Data Analytics and Decision Support, and Division of Medical Toxicology and Precision Medicine, Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Barry H. Rumack
- Department of Emergency Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hartmut Jaeschke
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
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16
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Pourbagher-Shahri AM, Schimmel J, Shirazi FM, Nakhaee S, Mehrpour O. Use of fomepizole (4-methylpyrazole) for acetaminophen poisoning: A scoping review. Toxicol Lett 2021; 355:47-61. [PMID: 34785186 DOI: 10.1016/j.toxlet.2021.11.005] [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: 01/28/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Acetaminophen (paracetamol, APAP) poisoning is a prominent global cause of drug-induced liver injury. While N-acetylcysteine (NAC) is an effective antidote, it has therapeutic limitations in massive overdose or delayed presentation. The objective is to comprehensively review the literature on fomepizole as a potential adjunct antidote for acetaminophen toxicity. METHODS A scoping review was performed using standardized search terms from inception through July 2021. RESULTS Reports on fomepizole as a therapeutic adjunct for APAP toxicity span heterogeneous types of evidence. Eleven preclinical studies (in vitro and animal), fourteen case reports/series, and one human volunteer study were included. Fomepizole's action is mediated by inhibition of CYP2E1 to prevent oxidant stress generation, and inhibition of c-Jun N-terminal kinase (JNK) to decrease amplification of oxidant stress signaling to mitochondria. Studies have shown a reduction in oxidative metabolites likely by shunting metabolism away from CYP2E1 and a resultant decrease in liver injury in animals, independent of CYP2E1 interactions. Fomepizole has been linked to few adverse effects. CONCLUSION Based on in vitro and animal studies, and bolstered by case reports, fomepizole likely offers benefit as an adjunct antidote for APAP toxicity, however this remains to be shown in a human trial. NAC remains the standard of care antidote, but given that fomepizole is approved and generally safe, it may be considered for APAP toxicity as off-label use by experienced clinicians, in rare circumstances associated with increased risk of hepatotoxicity despite standard NAC dosing. The marginal clinical benefit of fomepizole adjunct therapy beyond NAC monotherapy remains to be clearly defined, and routine use for APAP overdose is premature based on current evidence.
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Affiliation(s)
| | - Jonathan Schimmel
- Dept of Emergency Medicine, Division of Medical Toxicology, Mount Sinai Hospital Icahn School of Medicine, New York, NY, USA
| | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran; Data Science Institute, Southern Methodist University, Dallas, Texas, USA; Scientific Unlimited Horizon, Tucson, AZ, USA.
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17
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Methanol Poisoning Leading to Brain Death: A Case Report. J Crit Care Med (Targu Mures) 2021; 8:66-70. [PMID: 35274058 PMCID: PMC8852284 DOI: 10.2478/jccm-2021-0039] [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: 03/06/2021] [Accepted: 10/10/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The COVID-19 pandemic has put increased stress on medical systems, infrastructure, and the public in expected and unexpected ways. This case report summarises an unexpected case of methanol poisoning from hand sanitiser ingestion due to changes in industry regulations, increased demand for cleaning products and severe psychosocial stressors brought on by the pandemic. Severe methanol toxicity results in profound metabolic disturbances, damage to the retina and optic nerves, and potentially death. Case Presentation The patient was a 26-year-old male with alcohol use disorder who presented with one day of nausea, vomiting, and abdominal pain after consuming hand sanitiser. Within a few hours, the patient had suffered multiple seizures, cardiac arrests and required admission to the ICU for emergent management of methanol poisoning. EEG and brain perfusion imaging were performed to confirm brain death, given concerns about the cranial nerve exam after methanol poisoning. Conclusions While rare, methanol toxicity remains a potentially fatal poisoning in the United States and worldwide. When healthcare and public resources are strained, healthcare professionals must consider particularly abnormal presentations. In patients suspected of brain death from methanol toxicity, cranial nerve examination may be unreliable. Therefore, additional testing is necessary to confirm brain death.
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18
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Alzahrani AY, Ammar YA, Salem MA, Abu-Elghait M, Ragab A. Design, synthesis, molecular modeling, and antimicrobial potential of novel 3-[(1H-pyrazol-3-yl)imino]indolin-2-one derivatives as DNA gyrase inhibitors. Arch Pharm (Weinheim) 2021; 355:e2100266. [PMID: 34747519 DOI: 10.1002/ardp.202100266] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022]
Abstract
A series of 3-[(1H-pyrazol-3-yl)imino]indolin-2-one derivatives were designed using the molecular hybridization method, characterized using different spectroscopic techniques, and evaluated for their in vitro antimicrobial activity. Most of the target compounds demonstrated good to moderate antimicrobial activity compared with ciprofloxacin and fluconazole. Four compounds (8b, 9a, 9c, and 10a) showed encouraging results, with minimal inhibitory concentration (MIC) values (53.45-258.32 µM) comparable to those of norfloxacin (100.31-200.63 µM) and ciprofloxacin (48.33-96.68 µM). Noticeably, the four derivatives revealed excellent bactericidal and fungicidal activities, except for the bacteriostatic potential of compounds 8b and 9a against Escherichia coli and Staphylococcus aureus, respectively. The time-killing kinetic study against S. aureus confirmed the efficacy of these derivatives. Furthermore, two of the four promising derivatives, 9a and 10a, could prevent the formation of biofilms of S. aureus without affecting the bacterial growth at low concentrations. A combination study with seven commercial antibiotics against the multidrug-resistant bacterium P. aeruginosa showed a notable reduction in the antibiotic MIC values, represented mainly through a synergistic or additive effect. The enzymatic assay implied that the most active derivatives had inhibition potency against DNA gyrase comparable to that of ciprofloxacin. Molecular docking and density functional theory calculations were performed to explore the binding mode and study the reactivity of the promising compounds.
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Affiliation(s)
- Abdullah Y Alzahrani
- Department of Chemistry, Faculty of Science and Arts, King Khalid University, Mohail, Assir, Saudi Arabia
| | - Yousry A Ammar
- Department of Chemistry, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Mohamed A Salem
- Department of Chemistry, Faculty of Science and Arts, King Khalid University, Mohail, Assir, Saudi Arabia.,Department of Chemistry, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Mohammed Abu-Elghait
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Ahmed Ragab
- Department of Chemistry, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt
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19
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Paret N, Grenet G, Nguyen K, Vial T, Patat AM. Fomépizole : quel schéma thérapeutique recommander ? (Hors dialyse). TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Md Noor J, Hawari R, Mokhtar MF, Yussof SJ, Chew N, Norzan NA, Rahimi R, Ismail Z, Singh S, Baladas J, Hashim NH, Mohamad MIK, Pathmanathan MD. Methanol outbreak: a Malaysian tertiary hospital experience. Int J Emerg Med 2020; 13:6. [PMID: 32028888 PMCID: PMC7006424 DOI: 10.1186/s12245-020-0264-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/21/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources. Methodology A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre. Result A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications. Osmolar gap and lactate had strong correlations with patient’s mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable. Conclusion The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.
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Affiliation(s)
- J Md Noor
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - R Hawari
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - M F Mokhtar
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - S J Yussof
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N Chew
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N A Norzan
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - R Rahimi
- Department of Pathology, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Z Ismail
- Department of Public Health & Preventative Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - S Singh
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - J Baladas
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - N H Hashim
- Emergency & Trauma Department, Hospital Sg Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - M I K Mohamad
- Emergency Department, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
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ST-elevation in ethylene glycol toxicity mimicking myocardial infarction. J Electrocardiol 2019; 58:128-131. [PMID: 31838313 DOI: 10.1016/j.jelectrocard.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/21/2022]
Abstract
Electrocardiographic changes due to ethylene glycol toxicity are described in a 37-year-old woman who presented with intentional overdose. She received prompt treatment with dialysis and fomepizole, which reversed profound metabolic acidosis. ST-elevation in leads I, aVL, and aVR were observed 87 h after admission along with diffuse repolarization abnormalities. Coronary angiography found no evidence of coronary artery disease, and echocardiogram revealed normal left ventricle size and a mildly hypokinetic basal inferior wall. Diffuse repolarization abnormalities persisted for several days. Review of literature supports the diagnosis of myocarditis induced by toxic metabolites of ethylene glycol in context of hepatic and renal failure.
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The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e28. [PMID: 31410405 PMCID: PMC6683589 DOI: 10.22114/ajem.v0i0.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: This review discusses the range of clinical presentations seen with poisonings by the major toxic alcohols--methanol, ethylene glycol, and isopropyl alcohol. It outlines a straightforward diagnostic strategy and discusses in detail the current treatment recommendations. Evidence acquisition: The authors conducted a literature search of primary and secondary sources related to the topic. For treatment recommendations, search restrictions included articles published between 2008 and 2019. For background information, search restrictions included articles written from 1990 – present. Results: This review discusses in detail how the diagnosis can be made via clinical signs, symptoms, and laboratory values as well as the most recent treatment recommendations. This paper will also discuss the limitations of the emergency department workup and how the absence of particular laboratory findings does not necessarily rule out the diagnosis. Conclusion: Poisoning with methanol, ethylene glycol, and isopropanol present diagnostic and therapeutic challenges to emergency physicians. Toxic alcohol poisonings lead to an elevated osmolar gap and, with the exception of Isopropanol, a metabolic acidosis. In order for the timely initiation of life-saving treatment, emergency physicians need a solid understanding of the pathophysiology, clinical presentation, laboratory workup, and treatment.
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Bellouard R, Deslandes G, Gregoire M, Pineau A, Dailly E, Jolliet P, Monteil-Ganière C. Ethylene glycol poisoning requiring critical care: Three case reports. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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Song CH, Bae HJ, Ham YR, Na KR, Lee KW, Choi DE. A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy. Electrolyte Blood Press 2018; 15:47-51. [PMID: 29399024 PMCID: PMC5788815 DOI: 10.5049/ebp.2017.15.2.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 12/02/2022] Open
Abstract
Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.
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Affiliation(s)
- Chang Hun Song
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hong Jin Bae
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Successful Resuscitation of a Patient with Life-Threatening Metabolic Acidosis by Hemodialysis: A Case of Ethylene Glycol Intoxication. Case Rep Nephrol 2017; 2017:9529028. [PMID: 28811944 PMCID: PMC5547705 DOI: 10.1155/2017/9529028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. CASE PRESENTATION A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury. He was transferred to the university hospital; hemodialysis was initiated because of hyperkalemia and severe metabolic acidosis. On recovering consciousness, he admitted having ingested antifreeze solution. Thirty-seven days after admission, the patient was discharged without requiring HD. CONCLUSIONS We reported a case of ethylene glycol intoxication who presented with a life-threatening metabolic acidosis. In a state of severe circulatory shock requiring catecholamines, hemodialysis should be avoided, and continuous hemodiafiltration may be a preferred approach. However, one should be aware of the possibility of intoxication by unknown causes, and hemodialysis could be life-saving with its superior ability to remove toxic materials in such cases.
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Zakharov S, Nurieva O, Kotikova K, Belacek J, Navratil T, Pelclova D. Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning. MONATSHEFTE FUR CHEMIE 2016; 148:409-419. [PMID: 28344362 PMCID: PMC5346122 DOI: 10.1007/s00706-016-1846-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022]
Abstract
ABSTRACT Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012-2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6-32.2) mmol dm-3]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57-21.34; p < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving (p < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85-23.02; p < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission. GRAPHICAL ABSTRACT
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Olga Nurieva
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Katerina Kotikova
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | - Jaromir Belacek
- First Faculty of Medicine, Institute of Biophysics and Informatics, Charles University in Prague, Salmovska 1, 120 00 Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i., Dolejškova 3, 182 23 Prague 8, Czech Republic
- First Faculty of Medicine, Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
- First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic
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Zakharov S, Pelclova D, Urban P, Navratil T, Nurieva O, Kotikova K, Diblik P, Kurcova I, Belacek J, Komarc M, Eddleston M, Hovda KE. Use of Out-of-Hospital Ethanol Administration to Improve Outcome in Mass Methanol Outbreaks. Ann Emerg Med 2016; 68:52-61. [PMID: 26875060 DOI: 10.1016/j.annemergmed.2016.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Methanol poisoning outbreaks are a global public health issue, with delayed treatment causing poor outcomes. Out-of-hospital ethanol administration may improve outcome, but the difficulty of conducting research in outbreaks has meant that its effects have never been assessed. We study the effect of out-of-hospital ethanol in patients treated during a methanol outbreak in the Czech Republic between 2012 and 2014. METHODS This was an observational case-series study of 100 hospitalized patients with confirmed methanol poisoning. Out-of-hospital ethanol as a "first aid antidote" was administered by paramedic or medical staff before the confirmation of diagnosis to 30 patients; 70 patients did not receive out-of-hospital ethanol from the staff (12 patients self-administered ethanol shortly before presentation). RESULTS The state of consciousness at first contact with paramedic or medical staff, delay to admission, and serum methanol concentration were similar among groups. The median serum ethanol level on admission in the patients with out-of-hospital administration by paramedic or medical staff was 84.3 mg/dL (interquartile range 32.7 to 129.5 mg/dL). No patients with positive serum ethanol level on admission died compared with 21 with negative serum ethanol level (0% versus 36.2%). Patients receiving out-of-hospital ethanol survived without visual and central nervous system sequelae more often than those not receiving it (90.5% versus 19.0%). A positive association was present between out-of-hospital ethanol administration by paramedic or medical staff, serum ethanol concentration on admission, and both total survival and survival without sequelae of poisoning. CONCLUSION We found a positive association between out-of-hospital ethanol administration and improved clinical outcome. During mass methanol outbreaks, conscious adults with suspected poisoning should be considered for administration of out-of-hospital ethanol to reduce morbidity and mortality.
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Affiliation(s)
- Sergey Zakharov
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic.
| | - Daniela Pelclova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic; Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of the AS CR, Prague, Czech Republic
| | - Olga Nurieva
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Center, Department of Occupational Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, General University Hospital, Prague, Czech Republic
| | - Ivana Kurcova
- Department of Toxicology and Forensic Medicine, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Jaromir Belacek
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Knut Erik Hovda
- Norwegian CBRNe Center of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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He M, Potuck A, Kohn JC, Fung K, Reinhart-King CA, Chu CC. Self-Assembled Cationic Biodegradable Nanoparticles from pH-Responsive Amino-Acid-Based Poly(Ester Urea Urethane)s and Their Application As a Drug Delivery Vehicle. Biomacromolecules 2016; 17:523-37. [DOI: 10.1021/acs.biomac.5b01449] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mingyu He
- Department
of Fiber Science and Apparel Design, Cornell University, Ithaca, New York 14853-4401, United States
| | - Alicia Potuck
- Department
of Chemistry and Chemical Biology, Cornell University, Ithaca, New York 14853, United States
| | - Julie C. Kohn
- Nancy
E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Katharina Fung
- Nancy
E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Cynthia A. Reinhart-King
- Nancy
E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Chih-Chang Chu
- Department
of Fiber Science and Apparel Design, Cornell University, Ithaca, New York 14853-4401, United States
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Kumar P, Gogia A, Kakar A, Miglani P. An interesting case of characteristic methanol toxicity through inhalational exposure. J Family Med Prim Care 2015; 4:470-3. [PMID: 26285665 PMCID: PMC4535118 DOI: 10.4103/2249-4863.161359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methanol poisoning is rare but carries high risk of morbidity and mortality. Most of the cases witnessed in emergency are due to consumption of adulterated alcohol. Here we are reporting a very rare case of methanol poisoning through inhalational exposure leading to putamen necrosis and decreased visual acuity. He had dyselectrolytemia and metabolic acidosis which was successfully managed with early intervention. Its importance lies in the fact that inhalational methanol poisoning is an entity which if picked up early can prevent long-term neurological sequelae.
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Affiliation(s)
- Pratyush Kumar
- Department of Family Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Atul Gogia
- Department of Family Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Atul Kakar
- Department of Family Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Pratyush Miglani
- Department of Family Medicine, Sir Gangaram Hospital, New Delhi, India
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Suo A, Scozzafava J. Neurotoxic overdose in a young man: answer. J Clin Neurosci 2015; 23:170. [PMID: 27090922 DOI: 10.1016/j.jocn.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aleksi Suo
- Department of Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada.
| | - James Scozzafava
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Adult Critical Care Medicine, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
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