Methanol intoxication outbreak during the COVID-19 pandemic in Cape Town, South Africa: a case series

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).