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1.
Clinical Toxicology ; 60(SUPPL 1):99-100, 2022.
Article in English | EMBASE | ID: covidwho-1915451

ABSTRACT

Objective: Methanol poisoning may result in significant morbidity and mortality, particularly during poisoning outbreaks in lowand- middle-income countries (LMIC) [1]. Although not readily available to the public in South Africa, methanol may be used as a substitute for ethanol in alcoholic beverages or to fortify illicit spirits. Following the announcement of the global COVID-19 pandemic, the South African government declared a State of Emergency in March 2020 which amongst other things prohibited the consumption, sale and transportation of alcohol [2]. We aim to describe the clinical presentation, diagnosis, treatment and outcome of a series of cases presenting to a Cape Town hospital after reportedly drinking illicit alcohol. Case series: We performed a retrospective case record review using the available records for 19 of 24 patients presenting to False Bay Hospital during June 2020 with presumed methanol poisoning. Almost all the patients were male (n=18), with a mean age of 35.1 years (SD =7.3). At least half of the patients had central nervous system effects (n=12;headache, ataxia, confusion, weakness), as well as gastrointestinal symptoms (n=10;abdominal pain, nausea, vomiting), and 5 patients reported visual loss. Time from exposure to presentation varied from 12 hours to 8 days, with 47.4% (n=9) presenting within the first 24 hours. On admission, venous blood gas samples from the patients showed the following mean values: pH of 7.14 (SD =0.23);serum bicarbonate 17.4 (SD =8.5) mmol/L;base deficit of -7.8 (SD =11.6) mmol/L, and lactate concentration of 4.1 (SD =4.0) mmol/ L. Assays to measure methanol or formate concentrations were not performed as these are not routinely available. Ten patients (52.6%) received both ethanol via nasogastric tube and intravenous sodium bicarbonate. Haemodialysis was considered for one patient but never started due to intensive care unit (ICU) resource constraints with COVID-I9 admissions. The mortality rate was 26.3% (n=5) and one patient had ongoing visual loss. Conclusion: To the authors' knowledge, this is the first published data concerning a methanol poisoning outbreak in South Africa. As described in other LMICs, the mortality rate was high, diagnosis was difficult, and access to ethanol antidote and supportive care was challenging, particularly during the COVID-19 pandemic. (Table Presented).

2.
Clinical Toxicology ; 60(SUPPL 1):100, 2022.
Article in English | EMBASE | ID: covidwho-1915432

ABSTRACT

Objective: Poison centers frequently manage calls involving ethanol-containing hand sanitizers. During the 2020 COVID-19 pandemic, our Specialists in Poison Information sensed rising numbers of cases. The increased use was not surprising due to the desire to sanitize skin and reduce transmission of COVID-19. We sought to compare hand sanitizer trends pre-pandemic and during the pandemic including a sub-analysis for children 0-5 years. Methods: We queried the National Poison Data System for human exposures of all ages within our 4-state poison center from 1 January 2015 to 31 October 2021. Generic codes for all types of hand sanitizers were included plus 2 product codes for methanol-containing hand sanitizer. Data captured included age range, product type, reason, gender, route, clinical effect, medical outcome, month, management site, and therapies. The query was repeated for the same parameters in children 0-5 years old. Descriptive statistical analyses were utilized. Results: Our poison center managed 5,819 human hand sanitizer exposures during the study period;67% occurred in children 0-5 years old. From 2019 (n=723) to 2020 (n=1,272), hand sanitizer exposures increased by 76%, 38% [all ages, children 0-5 years];52% were male. Most [77%, 99%] of these exposures were unintentional and [89%, 96%] involved ingestion as the primary route and exposures in children 0-5 years represented 64% of the total number of ingestion cases. Exposures in 2020 occurred throughout the year with higher volumes in March and July through December. Most cases were managed on-site (non-hospital) [81%, 89%], with [18%, 11%] evaluated in or referred to a hospital. Most [87%, 89%] clinical outcomes were minor or no effect overall, with similar numbers in 2020 [82%, 87%]. The top clinical effect in children 0-5 years was vomiting. For all ages, the most common effects were vomiting, nausea, and drowsiness. There was one death involving an adult who intentionally consumed hand sanitizer as an alcohol substitute. The product was contaminated with methanol and he died from methanol intoxication. Non-ethanol or isopropanol hand sanitizers were involved in 10% of exposures during the study period and 19% of exposures in 2020. Conclusion: We confirmed our suspicion that hand sanitizer exposures rose significantly in 2020. Explanations include increased usage and availability in the home paired with more time spent at home overall due to coronavirus school restrictions, working from home, and quarantine. Fortunately, even during 2020, most medical outcomes resulted in none or minor effects. Additional sub-analyses are needed to characterize other aspects including non-ethanol hand sanitizer exposures.

3.
Clinical Toxicology ; 60(SUPPL 1):94, 2022.
Article in English | EMBASE | ID: covidwho-1915431

ABSTRACT

Objective: The global pandemic of coronavirus SARS-CoV-2 has been a serious stress test for healthcare systems in many countries, with a significant impact on the structure and number of acute chemical poisonings. The aim of this study was to examine the impact of the COVID-19 pandemic on the toxic-epidemiological situation in Azerbaijan. Methods: We conducted a comparative analysis of the database of the Poison Center in Baku during the 9 months of the pandemic period (20 March - 21 December 2020) with the data of the same period in 2019 and the previous decade (2009-2018). Results: The alarming dynamics of a significant increase in the number of alcohol surrogates, primarily methanol poisoning, was revealed. In the 10-year period 2009-2018, alcohol surrogates intoxication was only 0.09% (18 patients) of total poisoning cases (20,266), but during the study period of 2020 increased to 3.4% (32 patients of 946 poisoning cases). The mortality rate in the ethanol and alcohol surrogate intoxication group in 2019 was 7.5% (8/ 106) versus 28.3% (30/106) in March-December 2020. All fatal cases in the alcohol surrogate poisoning cohort were related to methanol, thus, the mortality rate of this pathology was 61.5% (16/26). At the same time, no case of methanol poisoning was recorded in March-December 2019, and in the previous decade (2010-2018), only 1 case of methanol intoxication was recorded. The source of methanol during the pandemic was ingestion of counterfeit medical alcohol and alcohol-containing disinfectant products purchased by the victims themselves in the pharmacy network. Conclusion: The COVID-19 pandemic and quarantine measures had a significant impact on the epidemiology of poisoning in Azerbaijan, with an increase in cases and mortality of methanol poisoning. The outbreak of methanol poisoning in Azerbaijan revealed many shortcomings and weaknesses in the country's public health system. Late or erroneous diagnosis, lack of knowledge and clinical experience in the diagnosis and management of poisoned patients, difficulties with laboratory and diagnostic confirmation of the diagnosis, restrictions in the treatment of patients, relating to the lack of an effective antidote (fomepizole) resulted in high mortality. Considering the almost complete absence of methanol poisoning in Azerbaijan over the previous decade, the question of the source of the methanol is raised. Until a few years ago, the only methanol plant in the Caucasus was opened in Azerbaijan with a production capacity of more than 400 thousand tons per year. The plant stores more than 48 thousand metric tons of finished product, and should be investigated for possible leakage to the illegal market.

4.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
5.
International Journal of Medical Toxicology and Forensic Medicine ; 12(1):36171, 2022.
Article in English | EMBASE | ID: covidwho-1780442

ABSTRACT

Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient's files and analyzed with appropriate statistical tests. Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients. Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication.

6.
Acute Med Surg ; 8(1): e715, 2021.
Article in English | MEDLINE | ID: covidwho-1557821

ABSTRACT

AIM: The aim of the current study was to evaluate the prevalence of coronavirus disease (COVID-19) in methanol-poisoned patients admitted to two toxicology academic centers during the COVID-19 outbreak and determine their clinical features and chest/brain computed tomography (CT) findings. METHODS: Methanol-poisoned patients who had been referred during the COVID-19 pandemic were evaluated for signs and symptoms of COVID-19 by chest CT scans and/or polymerase chain reaction test. RESULTS: A total of 62 patients with confirmed methanol poisoning were enrolled in the study, with a median (interquartile range) age of 35 (28-44) years. Thirty-nine (62.9%) survived. Nine (14.5%) were diagnosed to have COVID-19, of whom four survived. There was a significant correlation between COVID-19 disease and a history of alcohol consumption (p = 0.036; odds ratio 1.7; 95% confidence interval, 1.3-2.2). Univariate analysis showed significant differences between infected and noninfected patients regarding their urea and time for first and second hemodialysis sessions, as well as the duration of ethanol administration. CONCLUSIONS: In conclusion, during the pandemic, specific attention should be paid to patients with a history of alcohol ingestion and elevated creatinine, loss of consciousness, and severe acidosis as these signs/symptoms could be present in both COVID-19 and methanol poisoning, making differentiation between the two challenging.

7.
Clin Case Rep ; 9(10): e04943, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1469431

ABSTRACT

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37-year-old man with acute pancreatitis due to methanol poisoning during the COVID-19 pandemic.

8.
Ren Replace Ther ; 7(1): 43, 2021.
Article in English | MEDLINE | ID: covidwho-1348352

ABSTRACT

In May and June 2020, an outbreak of methanol poisoning arose in the southwest United States linked to ingestion of contaminated hand sanitizer imported during the coronavirus disease 2019 pandemic, ultimately resulting in over a dozen hospitalizations and at least four deaths in New Mexico and Arizona. In this report, we describe one of these cases in which profound methanol intoxication was successfully treated with the Tablo® Hemodialysis System, the first reported case of toxic alcohol poisoning treated with this novel device. We carry out a formal regression analysis of the serial methanol levels obtained in this case to conservatively estimate that intermittent hemodialysis with Tablo achieved a clearance of methanol of 239 mL/min (95% confidence interval, 173-305 mL/min), a clearance that is well within the previously published standard of care. We conclude by reviewing both the treatment of toxic alcohol poisoning and the determinants of small molecule clearance with hemodialysis, emphasizing the importance of optimizing the dialytic treatment of intoxications with extended treatment times and the use of high-efficiency dialyzers.

9.
Clin Toxicol (Phila) ; 59(11): 1009-1014, 2021 11.
Article in English | MEDLINE | ID: covidwho-1146385

ABSTRACT

BACKGROUND: The advent of COVID-19 increased attention to hand hygiene in prevention of disease transmission. To meet the increased demand for hand sanitizer during the pandemic, the US FDA issued an Emergency Use Authorization allowing new manufacturers and importers to enter the market. Some of the newly introduced hand sanitizer products contained methanol in lieu of ethanol or isopropanol. We describe five patients with fatal methanol poisoning resulting from hand sanitizers improperly containing methanol. CASE SUMMARY: Comparing a 5-month period from 2019 to the same time frame in 2020, the Arizona Poison and Drug Information Center has seen an increase of 124% in exposures to hand sanitizer. Of these cases, 28% involved methanol-contaminated hand sanitizer. Five of these patients died from methanol poisoning. All five cases had similar clinical features with severe high anion gap metabolic acidosis and, in four patients, elevated osmolal gap. Methanol concentrations were consistently very elevated, but these results were not available before the patients succumbed. Four of the patients received fomepizole and adjunctive care. Two patients received emergency extracorporeal therapy. All five died despite maximal treatment efforts. CONCLUSION: During the pandemic in 2020, there was a proliferation of alcohol-based hand sanitizers which contained methanol. Exposure to these products, which failed to meet regulatory standards, led to increased harm and death. Challenges to treatment of methanol poisoning, especially in rural areas, include lack of access to timely laboratory measurement of methanol concentrations and lack of available emergency hemodialysis without transfer of the patient.


Subject(s)
COVID-19 , Hand Sanitizers/poisoning , Methanol/poisoning , Poisoning/etiology , Adult , Arizona/epidemiology , Female , Hand Sanitizers/chemistry , Humans , Male , Middle Aged , Poison Control Centers/statistics & numerical data , Poisoning/therapy , Syndemic
10.
Alcohol ; 87: 25-27, 2020 09.
Article in English | MEDLINE | ID: covidwho-526523

ABSTRACT

Methanol poisoning has been a significant public health challenge for several decades in Iran. Even though alcohol use is highly criminalized, people consume illicit alcohol, which tends to be predominantly homemade and often contains methanol. Consequently, thousands of individual poisonings and hundreds of deaths annually are attributable to methanol poisoning. From February 19, 2020 through April 27, 2020, the 2019 coronavirus disease (COVID-19) epidemic rapidly expanded in Iran, and has been associated with 90,481 confirmed cases and 5710 confirmed deaths. Secondary to misinformation about the potential for alcohol to neutralize SARS-CoV-2, there has also been a significant escalation in methanol-related morbidity and mortality, with over 5000 people poisoned and over 500 confirmed deaths for the same period from February through April 2020. In some provinces, the case-fatality rate of methanol poisoning was higher than that from COVID-19. The high morbidity and mortality associated with methanol poisoning preceding and exacerbated by COVID-19 highlight the potential population level health impacts of the implementation of evidence-based education and harm reduction strategies focused on alcohol use across Iran.


Subject(s)
Coronavirus Infections/epidemiology , Methanol/poisoning , Pneumonia, Viral/epidemiology , Public Health , Syndemic , Alcohol Drinking/adverse effects , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Humans , Iran/epidemiology , Pandemics , Pneumonia, Viral/mortality , SARS-CoV-2
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