Methanol poisoning in the emergency department: methanol blood levels, prognosis, and sequelae outcomes.

Abstract

Background: Methanol poisoning is a critical condition marked by severe metabolic acidosis, shock, and organ failure, often leading to high morbidity, mortality, and sequelae such as permanent blindness.

Aims: This study retrospectively analyzes methanol poisoning cases to provide insights into diagnosis, treatment, outcomes, and sequelae rates.

Methods: Patients diagnosed with methanol poisoning in a university-based emergency department between 2015 and 2023 were analyzed. Data on demographics, presenting complaints, diagnostics, treatments, hospitalization, outcomes, and sequelae were collected.

Results: Among 116 patients, the mean age was 48.3 ± 13.5 years, and 94.8% (n = 110) were male. Alcohol poisoning accounted for 110 cases, while six involved other substances. Eighty-nine patients were discharged, and 27 died. Ocular findings predominated among survivors, while altered consciousness was the most common complaint in deceased patients. Deceased patients exhibited significantly lower pH and HCO₃ levels and higher base deficit, anion gap, and lactate levels. Blood methanol levels (mean, 64.5 ± 79.9 mg/dL) showed no correlation with mortality. Treatments included hemodialysis (89.7%), hemofiltration (19.8%), ethyl alcohol (77.6%), fomepizole (15%), and NaHCO₃ (78.1%). Visual sequelae developed in 33.7% of patients, while neurologic sequelae occurred in 6.2%.

Conclusion: Methanol poisoning remains a severe clinical issue with high morbidity and mortality. Low pH, HCO₃, and high anion/lactate levels are poor prognostic indicators. Early treatment improves outcomes, yet disabling visual sequelae are frequent. Developing rapid diagnostic kits for methanol and formic acid detection is essential for improving early diagnosis and management.