Fatal prognosis of methanol toxicity: identification of predictive factors

Human methanol poisoning is characterized by serious visual impairment, hepatic toxicity, formic acidosis, central nervous system toxicity, and death. This study was conducted on all patients admitted to Ain Shams Toxicology Centre because of methanol toxicity over one year, form January 1, 2004 to December 31, 2004. The patients were divided into two main groups; Group I included patients who survived after methanol poisoning meanwhile group II included patients who died after methanol poisoning. All patients were clinically examined for cardiovascular system manifestations, neurological, ophthalmic and effects of acidosis. All patients were subjected to routine investigation including renal profiles and liver profiles, as well as specific investigations mainly arterial blood gases and serum electrolytes. Also, data about if the patient was in need for and had haemodialysis was registered. Patients in group I presented with tachycardia, hypertension, pallor, sweating, blurring of vision, and some of them were agitated. On the other hand patients in group II showed hypertension, arrhythmias, convulsion and coma [grade III, IV], elevated renal profiles [serum creatinine mainly], together with hyperkalaemia and sever acidosis. Comparisons between group I and group II were done using student's t-test for continuous variables and Person's Chi-square test for categorical variables. The adjusted predicted factors for fatal prognosis were obtained using the logistic regression analysis. The results of the study revealed that mortality was much more prevalent among those who suffered from significant cardiovascular, CNS, ophthalmic, and renal signs of toxicity together with metabolic acidosis and hyperkalaemia. The multivariable analysis has identified one independent predictive factor significantly associated with fatal prognosis. This factor was convulsion [p < 0.001]. It can be concluded that early diagnosis and management of methanol poisoning may improve survival. Also, cardiovascular, CNS toxic manifestations and metabolic acidosis were strong predictors of methanol poisoning out come. Our results call for further investigation of predictive risk factors for the fatal prognosis of methanol toxicity; future studies preferably should include measuring of serum and tissue formic acid, and performed on large prospective cohorts over several years, to increase their internal validity

Evaluation of self-poisoned patients in poison control centre of Ain Shams University as regards poisons, age and sex.[prospective study]

Self-poisoning is a common method of attempting suicide and its rate is increasing in recent years. It is the second common method of suicide after hanging in some countries especially in young people. The objective of this study is to evaluate the self-poisoned cases admitted to poison control centre [P.C.C] of Ain Shams University Hospitals within the period of 1/6/2003 to 31/8/2003. The most common poisons were studied and the percentage of self-poisoning to the total cases of toxicity admitted to the centre as regard age and sex, in relation to the poison used. Self-poisoned patients were classified according to the type of poisoning into thirteen groups; patients took insecticides [group I], patients took rodenticides [group II], patients took chemicals [group III], patients took CNS drugs [group IV], patients took analgesics [group V], patients took CVS drugs [group VI], patients took chest preparations [group VII], patients took endocrine drugs [group VIII], patients took GIT preparations [group IX], patients took vitamins and minerals [group X], patients took unknown poisons [group XI], patients took anti-infective drugs [group XII] and patients took mixed poisons [group XIII]. Age groups were classified into: < 15 years, 15-24 years, 25-34 years and >/= 35 years. From this study, it was concluded that self-poisoning is a major health problem in Egypt accounting for 19.85% of the total number of patients admitted to the PCC especially among young adult females. The majority of self-poisoned patients were in the age group 15-24 years [74.5%] with female to male ratio [2.1:1]. The most common substance taken was insecticides [34.6%] mainly organophosphorous followed by CNS drugs [13.9%]. The majority of cases had no past history of previous suicidal attempts, drug or alcohol abuse, chronic or fatal disease or diagnosed psychiatric history. Self-poisoning affects people with major life problems. It is recommended that in order to minimize the prevalence of self-poisoning, several points should be taken into consideration. There must be a plan for education about self-poisoning, its prevalence and risk factors in order to create awareness especially among families having young adults. There must be proper religious education in different types of media and trials to solve problems of groups at high risk [young adults, females, students]. Proper restrictions should be taken in pharmacies and shops from which pharmaceutical and non pharmaceutical poisons can be easily obtained. Drugs must be given through written prescriptions and the doses and duration of treatment must be clear in order to limit the amount obtained