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Luo L, Zhu X, Li J, Yang F, Xiong Y, Xie Y. Severe visual loss caused by inhalational methanol poisoning in fireworks production: A report on 3 cases. Am J Ind Med 2022; 65:149-154. [PMID: 34825401 DOI: 10.1002/ajim.23315] [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: 08/22/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Workers in fireworks production are mainly at risk for explosion injury. However, there are few reports on the consequences of methanol poisoning in fireworks laborers. CASE PRESENTATION We report on three patients with visual loss caused by inhalation exposure to high concentrations of methanol, who were engaged in the granulation process of the fireworks manufacturing industry. They presented with severe metabolic acidosis and visual impairments, accompanied by headache, chest tightness, shortness of breath, dizziness, and vomiting. All were diagnosed with acute methanol poisoning. One patient developed bilateral blindness and two patients improved after timely hemodialysis treatment. CONCLUSIONS These case reports emphasize the risk of methanol poisoning in the fireworks industry or other factories using commercial alcohol with high methanol content. Early hemodialysis intervention and metabolic acidosis correction are crucial for rescuing visual impairment caused by methanol exposure. Awareness and supervision of commercial alcohol use are indispensable for similar industrial processes.
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Affiliation(s)
- Lei Luo
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine Hunan Normal University Changsha PR China
- Department of Occupational Health Changsha Center for Disease Control and Prevention Changsha PR China
| | - XueQin Zhu
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine Hunan Normal University Changsha PR China
| | - JiMeng Li
- Department of Occupational Health Changsha Center for Disease Control and Prevention Changsha PR China
| | - Feng Yang
- Department of Occupational Health Changsha Center for Disease Control and Prevention Changsha PR China
| | - YanYan Xiong
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine Hunan Normal University Changsha PR China
| | - Ying Xie
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine Hunan Normal University Changsha PR China
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Liberski S, Kaluzny BJ, Kocięcki J. Methanol-induced optic neuropathy: a still-present problem. Arch Toxicol 2022; 96:431-451. [PMID: 34988610 PMCID: PMC8731680 DOI: 10.1007/s00204-021-03202-0] [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: 10/24/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
Methanol-induced optic neuropathy (Me-ION) is a serious condition that may result in long-term or irreversible visual impairment or even blindness secondary to damage and loss of function of the optic nerve and retina. Me-ION shows a tendency to occur as mass poisonings around the world with a clear predilection for poor societies in developing countries. The main mechanism underlying the molecular basis of Me-ION is the inhibition of the mitochondrial oxidative phosphorylation process through the binding of the toxic metabolite of methanol—formic acid—with the key enzyme of this process—cytochrome c oxidase. However, other mechanisms, including damage to the eye tissues by oxidative stress causing the intensification of the oxidative peroxidation process with the formation of cytotoxic compounds, as well as an increase in the synthesis of pro-inflammatory cytokines and influence on the expression of key proteins responsible for maintaining cell homeostasis, also play an important role in the pathogenesis of Me-ION. Histopathological changes in the eye tissues are mainly manifested as the degeneration of axons and glial cells of the optic nerve, often with accompanying damage of the retina that may involve all its layers. Despite the development of therapeutic approaches, persistent visual sequelae are seen in 30–40% of survivors. Thus, Me-ION continues to be an important problem for healthcare systems worldwide.
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Affiliation(s)
- Sławomir Liberski
- Department of Ophthalmology, Poznan University of Medical Sciences, ul. Augustyna Szamarzewskiego 84, 61-848, Poznań, Poland.
| | - Bartlomiej J Kaluzny
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, ul. Kornela Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, ul. Augustyna Szamarzewskiego 84, 61-848, Poznań, Poland
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Emami A, Javanmardi F, Keshavarzi A, Pirbonyeh N. Hidden threat lurking behind the alcohol sanitizers in COVID-19 outbreak. Dermatol Ther 2020; 33:e13627. [PMID: 32436262 PMCID: PMC7280687 DOI: 10.1111/dth.13627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
The ongoing COVID‐19 pandemic has made various challenges for communications all over the world. Nowadays hand hygiene practices with alcohol sanitizers are an unavoidable reality for many people, which cause skin dryness and flaking. The current short communication has been explained about monitoring the quality control of alcohol concentrations and hand rub formulation, which needs more attention and should consider meticulous in this crisis.
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Affiliation(s)
- Amir Emami
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Infection Control Committee, Vice Chancellor of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Javanmardi
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolkhalegh Keshavarzi
- Surgery Department, General Surgery, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pirbonyeh
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gómez Perera S, Rodríguez Talavera I, Tapia Quijada HE, Guerrero-Mártir M, Díaz de Aguilar Osona M, Falcón Roca R. Secondary visual loss due to inhalation and cutaneous poisoning by methanol and toluene. Presentation of a clinical case. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:231-235. [PMID: 32197876 DOI: 10.1016/j.oftal.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
Methanol poisoning is often described in the literature, but not transdermal or inhalational poisoning. It usually involves variable multi-organ damage, among which visual, neurological, and gastrointestinal involvement, as well as the metabolic and electrolyte changes that can lead to death. Contact with toluene by occupational or intentional inhalation may also cause neurological abnormalities. This article describes the case of a female patient who was seen in the Emergency Department due to bilateral visual loss secondary to accidental poisoning (inhalation-transdermal) with a solvent containing methanol and toluene. She had a favourable outcome during admission after treatment with ethanol in perfusion and corticosteroids.
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Affiliation(s)
- S Gómez Perera
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España.
| | - I Rodríguez Talavera
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España
| | - H E Tapia Quijada
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España
| | - M Guerrero-Mártir
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España
| | - M Díaz de Aguilar Osona
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España
| | - R Falcón Roca
- Graduado en Medicina, Servicio de Oftalmología, Hospital Universitario de Canarias, Tenerife, España
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Ma Z, Jiang H, Wang J. Clinical analysis of severe visual loss caused by inhalational methanol poisoning in a chronic process with acute onset:a retrospective clinical analysis. BMC Ophthalmol 2019; 19:124. [PMID: 31174513 PMCID: PMC6554876 DOI: 10.1186/s12886-019-1127-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To analyze the clinical features and prognosis of the visual loss resulted from inhalational methanol poisoning in 8 Chinese patients. METHODS Eight consecutive patients seen at the Beijing Tongren Hospital of Capital Medical University, Beijing, China between January 2003 to August 2017, with complains of vision loss in both eyes, identified as inhalational methanol poisoning. Detailed medical history was extracted. All patients underwent optic nerve and brain magnetic resonance imaging (MRI) scan, laboratory tests, and visual function analysis. Treatment protocols were large dosage of methylprednisolone and B vitamins over 3 months. Patients were seen at 3-month intervals until a year. RESULTS Eight patients with optic neuropathy caused by inhalation toxicity of methanol were under observation, whose methanol-contact time spans were form 4 days to 5 years for occupational exposure. All the patients had acute onset, transient systemic symptoms on early stage, both eyes involved with severe visual impairment (visual acuity 0.1 or even worse). Retrobulbar optic nerves (ONs) were the major sites involved. Optic nerve MRI scan showed increased signal of bilateral ONs in the orbit and the canal parts, with enhancement. After treatment, the visual function of these patients got improved in different degree in a year follow-up, but not satisfactorily. CONCLUSIONS Inhalational methanol toxicity may lead to serious damage to ON in a process of chronic intoxication with acute attack, and with poor prognosis.
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Affiliation(s)
- Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Hanqiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
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Vural S. TRANSDERMAL METHANOL INTOXICATION VIA FOLK MEDICINE. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2019. [DOI: 10.33706/jemcr.551137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhi FY, Liu J, Ma XP, Hong J, Zhang J, Zhang D, Zhao Y, Wu LJ, Yang YT, Wu DY, Xie C, Wu LX, Zhang CH. Manual Acupuncture for Optic Atrophy: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:1735967. [PMID: 30713567 PMCID: PMC6332962 DOI: 10.1155/2019/1735967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/11/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022]
Abstract
Objectives. This systematic review aims to critically evaluate the efficacy of manual acupuncture for optic atrophy. Eight English and Chinese databases, including Cochrane Library, EMbase, PubMed, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Database (CBM), as well as ongoing trials registered with the WHO International Clinical Trials Registry Platform, were searched to identify eligible randomized controlled trials (RCTs) studying manual acupuncture for optic atrophy compared to medication alone. The quality of evidence was assessed using Cochrane Collaboration's risk of bias tool. Meta-analysis was performed using Review Manager version 5.3. Nine studies were identified and included for meta-analysis. The meta-analysis showed significant differences in favor of manual acupuncture or manual acupuncture plus medication compared with medication alone in the following outcome measures: visual acuity (MD = 0.18, 95% CI [0.17, 0.20], P < 0.00001), mean sensitivity of visual field (MD = 2.11, 95% CI [1.90, 2.32], P < 0.00001), the latent period of P-VEP100 (MD = -6.80, 95% CI [-8.94, -4.66], P < 0.00001), the total effectiveness (264 eyes) (OR = 3.22, 95% CI [1.88, 5.51], P<0.0001), and the total effectiveness (344 participants) (OR = 4.29, 95% CI [2.56, 7.19], P < 0.00001). Despite statistical advantages of manual acupuncture in the literature, due to serious methodological flaws in study design, it cannot be concluded that manual acupuncture is more effective than medicine alone. It is essential that a properly controlled clinical trial is designed and controls are established to exclude placebo effects.
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Affiliation(s)
- Fang-Yuan Zhi
- Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
| | - Jie Liu
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Xiao-Peng Ma
- Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Jue Hong
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Ji Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
| | - Dan Zhang
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Yue Zhao
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Li-Jie Wu
- Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
| | - Yan-Ting Yang
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Dan-Yan Wu
- Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
| | - Chen Xie
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Ling-Xiang Wu
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Cui-Hong Zhang
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
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Robledo C, Saracho R. Intoxicación por metanol por inhalación de disolvente. Nefrologia 2018; 38:679-680. [DOI: 10.1016/j.nefro.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022] Open
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Dogan H, Yilmaz Karakus B, Serefoglu Cabuk K, Uzun O, Yenice H, Orucoglu A. Transdermal Spirit (Methanol) Poisoning: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e23767. [PMID: 28191327 PMCID: PMC5292112 DOI: 10.5812/ircmj.23767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/09/2014] [Accepted: 03/20/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Methanol is a highly toxic substance and methanol poisoning results in severe health situations. Methanol poisoning occurs when it is consumed by various methods such as orally, by inhalation, and transdermally. Transdermal poisoning is rarely seen and causes severe health complications. CASE PRESENTATION A 59-year-old male patient was admitted to the emergency room due to blurred vision and knee pain. He had wrapped alcohol soaked cotton around his knees because of pain, and left it for 10 hours at night. On physical examination the knees only exhibited redness. Upon funduscopic examination, signs of poisoning were not seen, but a high anion gap metabolic acidosis was shown by arterial blood gas analysis. Hemodialysis was performed for severe acidosis and the patient was admitted to the ICU. The patient was treated and discharged from the ICU without sequelae. CONCLUSIONS Methanol poisoning presents to the emergency department in our country with many different situations and with varying histories. In different parts of the world, transdermal intoxication cases may be more prevalent and they may be overlooked, therefore, we aimed to present this case.
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Affiliation(s)
- Hatice Dogan
- Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
- Corresponding Author: Hatice Dogan, Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey. Tel: +90-2124404000, Fax: +90-2124404242, E-mail:
| | - Banu Yilmaz Karakus
- Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Kubra Serefoglu Cabuk
- Department of Ophthalmology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Ozlem Uzun
- Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Yenice
- Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Aysun Orucoglu
- Department of Emergency Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
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Elkhamary SM, Fahmy DM, Galvez-Ruiz A, Asghar N, Bosley TM. Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonic-clonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days. The patient's serum methanol level was 20.4 mg/dL. She was treated with fomepizole and continuous venovenous hemodialysis (CVVHD) in the pediatric intensive care unit, and methanol levels decreased to 0 mg/dL after 12 hours. During follow-up, massive edema and subarachnoid hemorrhage in the occipital lobe were detected by computed tomography of the brain. The patient died after 7 days.Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant.
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Abstract
Methanol is a clear, colorless solvent used in antifreeze solutions, varnishes, cologne, copying machine fluids, perfume, spirit, paint, and fuel. Even small amounts of ingested methanol can cause acute permanent neurological dysfunction and irreversible blindness. Although there are many reports of methanol poisoning due to suicidal or accidental ingestion, reports of transdermal absorption are rare. We present a 68-year-old man with transdermal methanol intoxication applied to our hospital's emergency department with weakness, loss of vision, and altered state of consciousness.
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