Methanol outbreak: a Malaysian tertiary hospital experience

Area of Science:

• Toxicology
• Public Health
• Emergency Medicine

Background:

• Methanol poisoning outbreaks pose diagnostic challenges and require immediate intervention.
• High mortality rates are associated with delayed or inadequate treatment.
• This paper examines a specific methanol poisoning outbreak and its management complexities.

Purpose of the Study:

• To describe the clinical features and outcomes of a large methanol poisoning outbreak.
• To identify factors contributing to high mortality and morbidity.
• To evaluate management strategies in a resource-limited tertiary referral center.

Main Methods:

• Retrospective analysis of 31 patients presenting with methanol poisoning over 9 days.
• Inclusion of demographic data, clinical presentation, laboratory parameters, and outcomes.
• Comparison of laboratory values between survivors and non-survivors.

Main Results:

• Overall mortality rate was 61.3%, with 19.3% dead on arrival.
• Significant differences in pH, bicarbonate, lactate, potassium, osmolar gap, and anion gap between survivors and deceased.
• Survivors experienced complications such as toxic optic neuropathy and uveitis; most had no long-term sequelae.

Conclusions:

• Methanol poisoning outbreaks result in high mortality and significant morbidity, including visual impairment and neurological deficits.
• Contributing factors included language barriers, illness severity, late presentation, and limited access to antidotes (fomepizole) and dialysis.
• Management based on clinical presentation is crucial, and localized, adaptable guidelines are recommended for resource-limited settings.