MilliporeSigma
  • Home
  • Search Results
  • Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features.

Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features.

Clinical toxicology (Philadelphia, Pa.) (2014-10-28)
Sergey Zakharov, Daniela Pelclova, Pavel Urban, Tomas Navratil, Pavel Diblik, Pavel Kuthan, Jaroslav A Hubacek, Michal Miovsky, Jiri Klempir, Manuela Vaneckova, Zdenek Seidl, Alexander Pilin, Zdenka Fenclova, Vit Petrik, Katerina Kotikova, Olga Nurieva, Petr Ridzon, Jan Rulisek, Martin Komarc, Knut Erik Hovda
ABSTRACT

Methanol poisonings occur frequently globally, but reports of larger outbreaks where complete clinical and laboratory data are reported remain scarce. The objective of the present study was to report the data from the mass methanol poisoning in the Czech Republic in 2012 addressing the general epidemiology, treatment, and outcomes, and to present a protocol for the use of fomepizole ensuring that the antidote was provided to the most severely poisoned patients in the critical phase. A combined prospective and retrospective case series study of 121 patients with confirmed methanol poisoning. From a total of 121 intoxicated subjects, 20 died outside the hospital and 101 were hospitalized. Among them, 60 survived without, and 20 with visual/CNS sequelae, whereas 21 patients died. The total and hospital mortality rates were 34% and 21%, respectively. Multivariate regression analysis found pH < 7.0 (OR 0.04 (0.01-0.16), p < 0.001), negative serum ethanol (OR 0.08 (0.02-0.37), p < 0.001), and coma on admission (OR 29.4 (10.2-84.6), p < 0.001) to be the only independent parameters predicting death. Continuous hemodialysis was used more often than intermittent hemodialysis, but there was no significant difference in mortality rate between the two [29% (n = 45) vs 17% (n = 30), p = 0.23]. Due to limited stockpiles of fomepizole, ethanol was administered more often; no difference in mortality rate was found between the two [16% (n = 70) vs. 24% (n = 21), p = 0.39]. The effect of folate administration both on the mortality rate and on the probability of visual sequelae was not significant (both p > 0.05). Severity of metabolic acidosis, state of consciousness, and serum ethanol on admission were the only significant parameters associated with mortality. The type of dialysis or antidote did not appear to affect mortality. Recommendations that were issued for hospital triage of fomepizole administration allowed conservation of valuable antidote in this massive poisoning outbreak for those patients most in need.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Ethyl alcohol, Pure, 190 proof, ACS spectrophotometric grade, 95.0%
Sigma-Aldrich
4-Methylpyrazole hydrochloride, alcohol dehydrogenase inhibitor
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, ≥99%
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, suitable for cell culture, ≥96.5% (HPLC), ≥96.5% (spectrophotometric assay), from yeast
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, ≥95% (HPLC)
Sigma-Aldrich
Sodium formate, BioUltra, ≥99.0% (NT)
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide, pkg of 20 mg (per vial)
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide, pkg of 10 mg (per vial)
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide, pkg of 50 mg (per vial)
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, ≥96.5% (HPLC), ≥96.5% (spectrophotometric assay), from yeast
Supelco
Ethanol-80, 80 mg/dL in H2O, ampule of 10 × 1.2 mL, certified reference material, Cerilliant®
Supelco
Ethanol-300, 300 mg/dL in H2O, ampule of 10 × 1.2 mL, certified reference material, Cerilliant®
Supelco
Methanol solution, contains 0.10 % (v/v) formic acid, UHPLC, suitable for mass spectrometry (MS), ≥99.5%
Supelco
Ethanol-200 (5 ampules/kit), 200 mg/dL in H2O, ampule of 5 × 5 mL, certified reference material, Cerilliant®
Supelco
Ethanol-80, 80 mg/dL in H2O, ampule of 5 × 5 mL, certified reference material, Cerilliant®
Supelco
Ethanol-100 (5 ampules/kit), 100 mg/dL in H2O, ampule of 5 × 5 mL, certified reference material, Cerilliant®
Supelco
Ethanol-40, 40 mg/dL in H2O, ampule of 10 × 1.2 mL, certified reference material, Cerilliant®
Supelco
Ethanol-10, 10 mg/dL in H2O, pack of 10 × 1.2 mL ampules, certified reference material, Cerilliant®
Supelco
Ethanol-150, 150 mg/dL in H2O, ampule of 10 × 1.2 mL, certified reference material, Cerilliant®
Supelco
Ethanol-20 (5 ampules/kit), 20 mg/dL in H2O, ampule of 5 × 5 mL, certified reference material, Cerilliant®
Sigma-Aldrich
Ethyl alcohol, Pure, 190 proof, meets USP testing specifications
Sigma-Aldrich
Ethyl alcohol, Pure, 200 proof, anhydrous, ≥99.5%
Sigma-Aldrich
Ethyl alcohol, denatured, reagent grade
Sigma-Aldrich
Sodium formate, 99.998% trace metals basis
Sigma-Aldrich
Fomepizole, 99%
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, purified by column chromatography, ≥99%
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, Grade AA-1
Sigma-Aldrich
β-Nicotinamide adenine dinucleotide hydrate, ≥98%, BioUltra, from yeast
Sigma-Aldrich
Methanol solution, NMR reference standard, 4% in methanol-d4 (99.8 atom % D), NMR tube size 3 mm × 8 in.
Supelco
Methanol solution, NMR reference standard, 4% in methanol-d4 (99.8 atom % D), NMR tube size 5 mm × 8 in.