Suicide attempt using pure methanol with hospitalization of the patient soon after ingestion: case report / Tentativa de suicídio com metanol puro em paciente admitido precocemente após a ingestão: relato de caso

CONTEXT: Most patients with methanol poisoning typically show up one to several days after ingestion, presenting severe acidosis, visual disorders, or both. Reports of hospitalization less than 6 h after exposure are unusual. We describe a case of attempted suicide using methanol admitted 3 h after ingestion. CASE REPORT: A 52-year-old male was hospitalized 3 h after intentional ingestion of 150 ml of 99.9 percent methanol with no co-ingestion of ethanol. He was alert and cooperative, presenting nausea and vertigo, and reporting six episodes of vomiting. Physical examination showed no remarkable features. A blood sample for methanol and ethanol determination was obtained 4 h after ingestion. The result (available 10 h after ingestion) showed 70 mg/dl of methanol, without detectable ethanol. He was treated with a loading dose of 10 percent ethanol solution (7 ml/kg, intravenously), followed by a maintenance dose of 0.9-1.0 ml/kg/h intravenously (10 to 51 h); hemodialysis (19 to 27 h, together with 2.1 ml/kg/h of 10 percent ethanol intravenously); and folinic acid intravenously (50 mg every 6 h, from 4 to 51 h). He developed mild/moderate metabolic acidosis without acidemia and was discharged on day four after ophthalmological evaluation and cerebral computed tomography scan, without abnormalities. Follow-up revealed no sequelae. CONCLUSION: This could be classified as a potentially severe case of methanol poisoning, according to the amount and concentration of methanol ingested, and blood methanol concentration at 4 h. The good outcome was attributable to early hospitalization and early antidotal therapy with hemodialysis, starting at 10 and 19 h, respectively.

CONTEXTO: A maioria dos pacientes intoxicados por metanol se apresenta um a vários dias após a ingestão, com acidose grave e/ou alterações visuais, sendo rara a admissão com menos de seis horas da exposição. Descrevemos uma tentativa de suicídio com metanol puro admitido três horas após a ingestão. RELATO DE CASO: Homem de 52 anos, admitido três horas após ingestão intencional de 150 ml de metanol 99,9 por cento sem co-ingestão de etanol. Ele estava alerta e cooperativo, apresentando náuseas, vertigem e relatando seis episódios de vômitos. Sem achados relevantes no exame físico. Foi coletada amostra sanguínea para determinação dos níveis séricos de metanol e etanol em quatro horas, com resultado liberado em 10 horas, mostrando metanol = 70 mg/dl e etanol não detectável. O paciente foi tratado com uma dose de ataque intravenosa (IV) de etanol 10 por cento de 7 ml/kg, seguida por uma dose de manutenção de 0,9-1,0 ml/kg/h IV de 10 a 51 horas; hemodiálise (19 a 27 horas), recebendo, nesse período, 2,1 ml/kg/h de etanol 10 por cento IV e oito doses de ácido folínico IV (50 mg cada 6 horas, de 4 a 51 horas). Desenvolveu acidose metabólica leve/moderada, sem acidemia, sendo liberado no quarto dia de internação após avaliação oftalmológica e realização de tomografia computadorizada cerebral, sem alterações. Acompanhamento não revelou sequelas. CONCLUSÃO: O presente caso pode ser classificado como uma intoxicação potencialmente grave por metanol, considerando a quantidade e a concentração ingerida e o nível sérico de metanol obtido em quatro horas. A boa evolução pode ser atribuída ao intervalo entre a exposição e a admissão hospitalar, e o tratamento específico com o antídoto e a hemodiálise, respectivamente iniciados em 10 e 19 horas.

Effect of variation in site and time on the level of ethanol and methanol in postmortem blood samples

It is well recognized that postmortem [PM] drug levels in blood may be unstable as a consequence of redistribution artifact. Whereby drugs diffuse from their binding sites of high concentration in tissues and major organs, such as liver and lung, into blood. Also drugs can be expected to diffuse from gastric contents into blood. When measuring drug concentrations after death, it is important to consider the phenomenon of PM drug redistribution. PM drug concentrations may not be a true reflection of the antemortem one and as a result, wrong conclusions could be made about the cause of death. There is few published evidence for most drugs and poisons to show the important differences in their PM concentrations in blood and tissues according to choice of sampling site, sampling time, handling of samples including containers, preservation and documentation and type of laboratory investigation carried out on PM samples. The present work was carried out to evaluate experimentally in rabbits PM behavior of ethyl and methyl alcohol in relation to their concentration in different blood sampling sites at different time intervals. Furthermore to assess the effect of site of PM blood sampling on the level of ethyl alcohol and methyl alcohol at time of autopsy in human cadavers and compare it with the results from rabbit experiments. The study was conducted on ninety male rabbits as experimental animals, and the human cadavers that were positive on screening to ethanol [n = 4] and methanol [n = 3] during the period of the study. Rabbits were divided into three groups [30 rabbits each], two groups for each drug, which were given the LD50 of the drug. Blood samples [2ml] were drawn from right and left sides of the heart and femoral vein from each group of rabbits, immediately, twelve hours and twenty-four hours after death. As regards human cadavers, blood samples [5m1] were drawn from right and left sides of the beau and femoral vein at time of autopsy. Experimental and human blood sample extracts were analyzed by gas chromatography. The study showed that ethanol was detected in the control group after 12h PM. The highest mean value recorded was 681 g/ml in 24h PM Rt. cardiac. No significant changes could be detected in immediate PM blood concentration for ethanol and methanol from different sampling sites. The study also revealed that PM blood concentration for ethanol and methanol increased over time for different sampling sites. Where up to 24h PM femoral [peripheral] blood drug concentrations were the closest to the immediate PM values, followed by Rt. cardiac then Lt. cardiac blood. It was noticed also that up to 12h PM femoral [peripheral] blood methanol concentration could be used as a reliable indicator for the immediate PM values. Experimental animal studies, when interpreted carefully, are indicative of the PM drug changes observed in human, denoting that femoral [peripheral] blood is the best site for drug sampling

Brain biogenic amine levels after methanol administration: possible mechanism of action on central monoaminergic neurons in discrete areas of brain in Wistar rat.

Alterations in the steady state level of rat brain biogenic amines - dopamine, nor-epinephrine, epinephrine, serotonin and 5-hydroxy indole acetic acid, in response to intraperitoneal administration of methanol (3g/kg b.w.) were studied in discrete areas of the rat brain. The monoamine changes induced by methanol were quite different from those induced by ethanol consumption. They were also region-specific; hypothalamus being more vulnerable for methanol-induced monoamine changes. The effects produced by methanol were correlated with the blood and brain level of methanol at the given time, suggesting that the effects were dependent upon the local concentration of methanol in different brain regions. Acidosis induced by ammonium chloride and sodium formate administration did not alter the monoamine levels and therefore, the effects of methanol were not possibly due to acidosis. Blocking or delaying the metabolism of methanol either by 4-Methyl Pyrazole and 3-Amino 1,2,4-Triazole or by simultaneous administration of ethanol resulted in the potentiation of methanol effect. Therefore, it was concluded that methanol induced changes in brain biogenic amines were due to methanol per se and not due to metabolic end products viz. formaldehyde or formic acid.