Top

Published in:

Open Access 01-12-2022 | Intoxication | Case report

Methanol poisoning outbreak in Saudi Arabia: a case series

Authors: Rawan Eskandrani, Khalid Almulhim, Abdulla Altamimi, Abeer Alhaj, Shahd Alnasser, Laale Alawi, Eman Aldweikh, Khalid Alaufi, Bandr Mzahim

Published in: Journal of Medical Case Reports | Issue 1/2022

Abstract

Background

Outbreaks of methanol poisoning have been described in the medical literature in different regions around the world. Even though in Saudi Arabia a few outbreaks of methanol poisoning have occurred, they remain undocumented. Herein, we describe several cases of methanol poisoning in Saudi Arabia with the goal of increasing awareness about the dangers of methanol poisoning among healthcare staff.

Case presentation

Nine middle-aged Saudi patients (five men aged 24, 26, 27, 36, and 49 years and four females aged 19, 20, 24, and 25 years) were admitted to our emergency department after alcohol consumption. All patients presented with severe metabolic acidosis and some visual impairment. Treatment was initiated based on the clinical suspicion of methanol intoxication because of laboratory test limitations and time constraints. Patients showed improvement and favorable hospital outcomes after aggressive empirical treatment.

Conclusions

Many social and cultural factors influence the lack of reporting of methanol poisoning cases in Saudi Arabia. We believe it is important to document these outbreaks to increase the knowledge among healthcare providers and promote public health awareness. A high index of suspicion and the development of local public health networks to monitor, survey, follow-up, and facilitate data exchange can help healthcare providers recognize and aggressively treat affected individuals. Early empiric and aggressive management can greatly decrease morbidity and mortality despite challenges and limited resources.

Md Noor J, Hawari R, Mokhtar MF, Yussof SJ, Chew N, Norzan NA, Rahimi R, Ismail Z, Singh S, Baladas J, Hashim NH, Mohamad MIK, Pathmanathan MD. Methanol outbreak: a Malaysian tertiary hospital experience. Int J Emerg Med. 2020;13:6. https://doi.org/10.1186/s12245-020-0264-5.CrossRefPubMedPubMedCentral

Ahmad K. Methanol-laced moonshine kills 140 in Kenya. Lancet. 2000;356:1911. https://doi.org/10.1016/S0140-6736(05)73469-3.CrossRef

Levy P, Hexdall A, Gordon P, Boeriu C, Heller M, Nelson L. Methanol contamination of Romanian home-distilled alcohol. J Toxicol Clin Toxicol. 2003;41:23–8. https://doi.org/10.1081/clt-120018267.CrossRefPubMed

Barnard E, Baladurai S, Badh T, Nicol E. Challenges of managing toxic alcohol poisoning in a resource-limited setting. J R Army Med Corps. 2014;160:245–50. https://doi.org/10.1136/jramc-2013-000117.CrossRefPubMed

Gouda AS, Khattab AM, Mégarbane B. Lessons from a methanol poisoning outbreak in Egypt: six case reports. World J Crit Care Med. 2020;9:54–62. https://doi.org/10.5492/wjccm.v9.i3.54.CrossRefPubMedPubMedCentral

Hassanian-Moghaddam H. An educational and research opportunity for the largest university hospital poison control centers; Tehran and Cairo, Egypt. J Forensic Sci. 2013;3:64–5. https://doi.org/10.1016/j.ejfs.2013.03.001.CrossRef

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. 2014;52:1013–24. https://doi.org/10.3109/15563650.2014.974106.CrossRef

Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings. Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol. 1986;1:309–34. https://doi.org/10.1007/BF03259846.CrossRefPubMed

Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA. American Academy of Clinical Toxicology Ad Hoc Committee on the Treatment Guidelines for Methanol Poisoning. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40:415–46. https://doi.org/10.1081/CLT-120006745.CrossRefPubMed

10.

Hassanian-Moghaddam H, Zamani N. A brief review on toxic alcohols. Iran J Kidney Dis. 2016;10:7.

11.

Gonda A, Gault H, Churchill D, Hollomby D. Hemodialysis for methanol intoxication. Am J Med. 1978;64(5):749–58. https://doi.org/10.1016/0002-9343(78)90513-2.CrossRefPubMed

12.

Brent J, McMartin K, Phillips S, Aaron C, Kulig K, Methylpyrazole for Toxic Alcohols Study Group. Fomepizole for the treatment of methanol poisoning. N Engl J Med. 2001;344:424–9. https://doi.org/10.1056/NEJM200102083440605.CrossRefPubMed

13.

Eells JT, Black KA, Makar AB, Tedford CE, Tephly TR. The regulation of one-carbon oxidation in the rat by nitrous oxide and methionine. Arch Biochem Biophys. 1982;219:316–26. https://doi.org/10.1016/0003-9861(82)90162-X.CrossRefPubMed

14.

Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol poisoning: ocular and neurological manifestations. Optom Vis Sci. 2012;89:178–82. https://doi.org/10.1097/OPX.0b013e31823ee128.CrossRefPubMed

15.

Galvez-Ruiz A, Elkhamary SM, Asghar N, Bosley TM. Visual and neurologic sequelae of methanol poisoning in Saudi Arabia. Saudi Med J. 2015;36:568–74. https://doi.org/10.15537/smj.2015.5.11142.CrossRefPubMedPubMedCentral

16.

Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae—a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol. 2009;9:5. https://doi.org/10.1186/1472-6904-9-5.CrossRefPubMedPubMedCentral

17.

Sanaei-Zadeh H, Zamani N, Shadnia S. Outcomes of visual disturbances after methanol poisoning. Clin Toxicol. 2011;49:102–7. https://doi.org/10.3109/15563650.2011.556642.CrossRef

18.

Zakharov S, Pelclova D, Diblik P, Urban P, Kuthan P, Nurieva O, Kotikova K, Navratil T, Komarc M, Belacek J, Seidl Z, Vaneckova M, Hubacek JA, Bezdicek O, Klempir J, Yurchenko M, Ruzicka E, Miovsky M, Janikova B, Hovda KE. Long-term visual damage after acute methanol poisonings: longitudinal cross-sectional study in 50 patients. Clin Toxicol. 2015;53:884–92. https://doi.org/10.3109/15563650.2015.1086488.CrossRef

19.

Zakharov S, Nurieva O, Navratil T, Diblik P, Kuthan P, Pelclova D. Acute methanol poisonings: folates administration and visual sequelae. J Appl Biomed. 2014;12:309–16. https://doi.org/10.1016/j.jab.2014.04.001.CrossRef

20.

Sanaei-Zadeh H. Typical bilateral putaminal lesions of methanol intoxication. J Emerg Med. 2012;42:178–9. https://doi.org/10.1016/j.jemermed.2009.08.010.CrossRefPubMed

21.

Sefidbakht S, Rasekhi AR, Kamali K, Borhani Haghighi A, Salooti A, Meshksar A, Abbasi HR, Moghadami M, Nabavizadeh SA. Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology. 2007;49:427–35. https://doi.org/10.1007/s00234-007-0210-8.CrossRefPubMed

22.

Sharma VK, Tan JH. Post-hypoxic early selective putaminal necrosis followed by delayed extensive sub-cortical demyelination. Brain Inj. 2007;21:1199–202. https://doi.org/10.1080/02699050701633056.CrossRefPubMed

23.

Deniz S, Oppenheim C, Lehéricy S, Sharshar T, Lalam TF, Dormont D, Marsault C. Diffusion-weighted magnetic resonance imaging in a case of methanol intoxication. Neurotoxicology. 2000;21:405–8.PubMed

24.

Hantson P, Duprez T, Mahieu P. Neurotoxicity to the basal ganglia shown by magnetic resonance imaging (MRI) following poisoning by methanol and other substances. J Toxicol Clin Toxicol. 1997;35:151–61. https://doi.org/10.3109/15563659709001186.CrossRefPubMed

25.

Wargotz ES, Werner M. Asymptomatic blood methanol in emergency room patients. Am J Clin Pathol. 1987;87:773–5. https://doi.org/10.1093/ajcp/87.6.773.CrossRefPubMed

26.

Nanji AA. Absence of symptoms and acidosis in potentially lethal methanol poisoning. Ann Emerg Med. 1984;13:487. https://doi.org/10.1016/s0196-0644(84)80040-2.CrossRefPubMed

27.

Peterson CD. Oral ethanol doses in patients with methanol poisoning. Am J Hosp Pharm. 1981;38:1024–7. https://doi.org/10.1093/ajhp/38.7.1024.CrossRefPubMed

28.

Jacobsen D, Sebastian CS, Blomstrand R, McMartin KE. 4-Methylpyrazole: a controlled study of safety in healthy human subjects after single, ascending doses. Alcohol Clin Exp Res. 1988;12:516–22. https://doi.org/10.1111/j.1530-0277.1988.tb00235.x.CrossRefPubMed

29.

Li TK, Theorell H. Human liver alcohol dehydrogenase: inhibition by pyrazole and pyrazole analogs. Acta Chem Scand. 1969;23:892–902. https://doi.org/10.3891/acta.chem.scand.23-0892.CrossRefPubMed

30.

Blomstrand R, Ostling-Wintzell H, Löf A, McMartin K, Tolf BR, Hedström KG. Pyrazoles as inhibitors of alcohol oxidation and as important tools in alcohol research: an approach to therapy against methanol poisoning. Proc Natl Acad Sci USA. 1979;76:3499–503. https://doi.org/10.1073/pnas.76.7.3499.CrossRefPubMedPubMedCentral

31.

Blomstrand R, Ingemansson S-O. Studies on the effect of 4-methylpyrazole on methanol poisoning using the monkey as an animal model: with particular reference to the ocular toxicity. Drug Alcohol Depend. 1984;13:343–55. https://doi.org/10.1016/0376-8716(84)90002-4.CrossRefPubMed

32.

McMartin KE, Makar AB, Martin GA, Palese M, Tephly TR. Methanol poisoning. I. The role of formic acid in the development of metabolic acidosis in the monkey and the reversal by 4-methylpyrazole. Biochem Med. 1975;13:319–33. https://doi.org/10.1016/0006-2944(75)90171-4.CrossRefPubMed

33.

McMartin KE, Hedström K-G, Tolf B-R, Östling-Wintzell H, Blomstrand R. Studies on the metabolic interactions between 4-methylpyrazole and methanol using the monkey as an animal model. Arch Biochem Biophys. 1980;199:606–14. https://doi.org/10.1016/0003-9861(80)90318-5.CrossRefPubMed

34.

Jobard E, Harry P, Turcant A, Roy PM, Allain P. 4-Methylpyrazole and hemodialysis in ethylene glycol poisoning. J Toxicol Clin Toxicol. 1996;34:373–7. https://doi.org/10.3109/15563659609013806.CrossRefPubMed

35.

Noker PE, Tephly TR. The role of folates in methanol toxicity. Adv Exp Med Biol. 1980;132:305–15. https://doi.org/10.1007/978-1-4757-1419-7_32.CrossRefPubMed

36.

Black KA, Eells JT, Noker PE, Hawtrey CA, Tephly TR. Role of hepatic tetrahydrofolate in the species difference in methanol toxicity. Proc Natl Acad Sci USA. 1985;82:3854–8. https://doi.org/10.1073/pnas.82.11.3854.CrossRefPubMedPubMedCentral

37.

McMartin KE, Martin-Amat G, Makar AB, Tephly TR. Methanol poisoning. V. Role of formate metabolism in the monkey. J Pharmacol Exp Ther. 1977;201:564–72.PubMed

38.

Johlin FC, Fortman CS, Nghiem DD, Tephly TR. Studies on the role of folic acid and folate-dependent enzymes in human methanol poisoning. Mol Pharmacol. 1987;31:557–61.PubMed

39.

Martinasevic MK, Green MD, Baron J, Tephly TR. Folate and 10-formyltetrahydrofolate dehydrogenase in human and rat retina: relation to methanol toxicity. Toxicol Appl Pharmacol. 1996;141:373–81. https://doi.org/10.1006/taap.1996.0302.CrossRefPubMed

40.

Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014;44:480–8. https://doi.org/10.3109/00498254.2013.845705.CrossRefPubMed

41.

Coulter CV, Farquhar SE, McSherry CM, Isbister GK, Duffull SB. Methanol and ethylene glycol acute poisonings—predictors of mortality. Clin Toxicol. 2011;49:900–6. https://doi.org/10.3109/15563650.2011.630320.CrossRef

42.

Liu JJ, Daya MR, Carrasquillo O, Kales SN. Prognostic factors in patients with methanol poisoning. J Toxicol Clin Toxicol. 1998;36:175–81. https://doi.org/10.3109/15563659809028937.CrossRefPubMed

43.

Mahieu P, Hassoun A, Lauwerys R. Predictors of methanol intoxication with unfavourable outcome. Hum Toxicol. 1989;8:135–7. https://doi.org/10.1177/096032718900800209.CrossRefPubMed

44.

Jacobsen D, McMartin KE. Antidotes for methanol and ethylene glycol poisoning. J Toxicol Clin Toxicol. 1997;35:127–43. https://doi.org/10.3109/15563659709001182.CrossRefPubMed

45.

de Arriba G, Torres-Guinea M, Chevarría J, Basterrechea MA. Usefulness of prolonged haemodialysis in acute methanol poisoning. Nefrologia. 2008;28:664–5.PubMed

46.

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;23:37.PubMed

47.

Lachance P, Mac-Way F, Desmeules S, De Serres SA, Julien AS, Douville P, Ghannoum M, Agharazii M. Prediction and validation of hemodialysis duration in acute methanol poisoning. Kidney Int. 2015;88:1170–7. https://doi.org/10.1038/ki.2015.232.CrossRefPubMedPubMedCentral

48.

Methanol Toxicity Treatment & Management: Approach Considerations. 2020. https://emedicine.medscape.com/article/1174890-treatment. Accessed 4 Dec 2020.

49.

Chow MT, Di Silvestro VA, Yung CY, Nawab ZM, Leehey DJ, Ing TS. Treatment of acute methanol intoxication with hemodialysis using an ethanol-enriched, bicarbonate-based dialysate. Am J Kidney Dis. 1997;30:568–70. https://doi.org/10.1016/s0272-6386(97)90318-8.CrossRefPubMed

Title: Methanol poisoning outbreak in Saudi Arabia: a case series
Authors: Rawan Eskandrani
Khalid Almulhim
Abdulla Altamimi
Abeer Alhaj
Shahd Alnasser
Laale Alawi
Eman Aldweikh
Khalid Alaufi
Bandr Mzahim
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Intoxication
Published in: Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-022-03600-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Methanol poisoning outbreak in Saudi Arabia: a case series

Abstract

Background

Case presentation

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Right-sided colopleural fistula secondary to diverticular disease: a case report

Vascular thromboses with retroperitoneal fibrosis: a case report

Acute appendicitis during the recovery phase of dengue hemorrhagic fever: two case reports

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

Pheochromocytoma triggered by coronavirus disease 2019: a case report

Pharmacological counseling in hepatotoxicity induced by macitentan and selexipag: a case report