Document Type : Original Article
Authors
- Hoorvash Faraji Dana 1
- Mohammad reza Rafiei Tabatabaiei 2
- Shahrooz Yazdani 3
- Mostafa Qorbani 4
- Lida Shojaei Arani 5
1 Alborz University of Medical Science, Karaj, Iran
2 Medical Doctor, Alborz University of Medical Science Karaj, Iran
3 Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran
4 Non- communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
5 Emergency Department, Alborz University of Medical Science, Karaj, Iran
Abstract
Introduction: Methanol is the simplest yet toxic alcohol found in many households and industrial materials. Exposure to methanol can be hazardous, and if left untreated, can result in mortality or severe morbidity. Methanol poisoning is mostly accidental, but it can result in mortality and severe morbidity. Due to the high prevalence of ECG changes in patients with methanol poisoning, this study aimed to evaluate the relationship of these ECG changes with methanol poisoning in determining the prognosis of the patients.
Methods: This cross-sectional study was conducted on 114 patients with acute methanol poisoning at the Shahid Rajaei Hospital in Karaj, Alborz Province, Iran. Clinical, laboratory and ECG variables were evaluated. Furthermore, the gathered data were analyzed with SPSS software.
Results: 1.8% of patients had a PR interval of less than 121ms, and 3.5% had more than 200ms. Among various ECG changes, only PR intervals of more than were significantly associated with mortality. Patients with short QT intervals had the highest PCO2, PH, and HCO3. On the other hand, people with long QT had the lowest amount of PCO2, PH, and HCO3, which was statistically significant. Laboratory tests showed significant differences in serum potassium level and blood PH between died and survived patients.
Discussion and conclusion: In our study, the most common finding in ECG was sinus tachycardia, and short QT was the second most common finding, which is consistent with other studies. Our study found that in ECGs, only PR intervals more than 200 have a significant relationship with mortality, which supports previous studies. Finally, it was that mortality in patients with methanol poisoning is significantly associated with PR interval prolongation, acidosis, and hyperkalemia.
Keywords
- Kraut JA, Mullins ME. Toxic Alcohols. N Engl J Med. 2018 Jan 18;378(3):270-280. doi: 10.1056/NEJMra1615295. Erratum in: N Engl J Med. 2019 Jan 10;380(2):202. PMID: 29342392.
- Allister Vale, Ethanol,Medicine, Volume 35, Issue 11, 2007, Pages 615-616, ISSN 1357-3039, https://doi.org/10.1016/j.mpmed.2007.08.015.
- Chan APL, Chan TYK. Methanol as an Unlisted Ingredient in Supposedly Alcohol-Based Hand Rub Can Pose Serious Health Risk. Int J Environ Res Public Health. 2018 Jul 9;15(7):1440. doi: 10.3390/ijerph15071440. PMID: 29987197; PMCID: PMC6069146.
- Liesivuori J, Savolainen H. Methanol and formic acid toxicity: biochemical mechanisms. Pharmacol Toxicol. 1991 Sep;69(3):157-63. doi: 10.1111/j.1600-0773.1991.tb01290.x. PMID: 1665561.
- Sanaei-Zadeh H, Emamhadi M, Farajidana H, Zamani N, Amirfarhangi A. Electrocardiographic manifestations in acute methanol poisoning cannot predict mortality. Arh Hig Rada Toksikol. 2013 Jun;64(2):79-85. doi: 10.2478/10004-1254-64-2013-2285. PMID: 23819935.
- Cavalli A, Volpi A, Maggioni AP, Tusa M, De Pieri G. Severe reversible cardiac failure associated with methanol intoxication. Postgrad Med J. 1987 Oct;63(744):867-8. doi: 10.1136/pgmj.63.744.867. PMID: 3447111; PMCID: PMC2428610.
- Jaff Z, McIntyre WF, Yazdan-Ashoori P, Baranchuk A. Impact of methanol intoxication on the human electrocardiogram. Cardiol J. 2014;21(2):170-5. doi: 10.5603/CJ.a2013.0053. Epub 2013 May 15. PMID: 23677726.
- Carolyn V. Coulter, Sarah E. Farquhar, Claire M. McSherry, Geoffrey K. Isbister & Stephen B. Duffull (2011) Methanol and ethylene glycol acute poisonings predictors of mortality, Clinical Toxicology, 49:10, 900-906, DOI: 10.3109/15563650.2011.630320
- Kute VB, Godara SM, Shah PR, Gumber MR, Goplani KR, Vanikar AV, Munjappa BC, Patel HV, Trivedi HL. Hemodialysis for methyl alcohol poisoning: a single-center experience. Saudi J Kidney Dis Transpl. 2012 Jan;23(1):37-43. PMID: 22237216.
- Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P, Hubacek JA, Miovsky M, Klempir J, Vaneckova M, Seidl Z, Pilin A, Fenclova Z, Petrik V, Kotikova K, Nurieva O, Ridzon P, Rulisek J, Komarc M, Hovda KE. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol (Phila). 2014 Dec;52(10):1013-24. doi: 10.3109/15563650.2014.974106. Epub 2014 Oct 25. PMID: 25345388.
- Lee CY, Chang EK, Lin JL, Weng CH, Lee SY, Juan KC, Yang HY, Lin C, Lee SH, Wang IK, Yen TH. Risk factors for mortality in Asian Taiwanese patients with methanol poisoning. Ther Clin Risk Manag. 2014;10:61-7. doi: 10.2147/TCRM.S51985. Epub 2014 Jan 17. PMID: 24465131; PMCID: PMC3900329.
- Shadnia S, Rahimi M, Soltaninejad K, Nilli A. Role of clinical and paraclinical manifestations of methanol poisoning in outcome prediction. J Res Med Sci. 2013 Oct;18(10):865-9. PMID: 24497857; PMCID: PMC3897070.
- Zahra Nekoukar, Zakaria Zakariaei, Fatemeh Taghizadeh, Fatemeh Musavi, Elham Sadat Banimostafavi, Ali Sharifpour, Nasrin Ebrahim Ghuchi, Mahdi Fakhar, Rabeeh Tabaripour, Sepideh Safanavaei, Methanol poisoning as a new world challenge: A review, Annals of Medicine and Surgery, Volume 66, 2021, 102445, ISSN 2049-0801, https://doi.org/10.1016/j.amsu.2021.102445.
(https://www.sciencedirect.com/science/article/pii/S2049080121003952)
- Navabi SJ, Eivazi M, Beiranvand B. An epidemiological study of patients with methanol poisoning and the factors affecting the prognosis of patients in imam khomeini hospital Kermanshah 2010-2015. Scientific Journal of Forensic Medicine. 2018;24(3):175-84. http://sjfm.ir/article-1-793-en.html [in persian]
- Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: epidemiology, clinical features and prognostic signs. J Intern Med. 2005 Aug;258(2):181-90. doi: 10.1111/j.1365-2796.2005.01521.x. PMID: 16018795.
- Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila). 2007;45(2):152-7. doi: 10.1080/15563650600956329. PMID: 17364632.
- Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia Sh. Prognostic factors in methanol poisoning. Hum Exp Toxicol. 2007 Jul;26(7):583-6. doi: 10.1177/0960327106080077. PMID: 17884962.
- Rzepecki J, Krakowiak A, Fiszer M, et al. [Acute methanol poisoning among patients of Toxicology Unit, Nofer Institute of Occupational Medicine in Łódź, during the period 2000-2009]. Przeglad Lekarski. 2012 ;69(8):431-434. PMID: 23243901.
)