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Brain hemorrhage associated with methanol poisoning
P T Phang1, L Passerini, B Mielke
1Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Abstract:
We recently treated seven patients who were victims of accidental methanol intoxication. Five of the seven patients died within 72 h of hospital admission. The two survivors were discharged from the hospital without visual or neurologic impairment. Hemorrhagic necrosis of the brain was found on CT scan and at autopsy in two patients who died. This complication of methanol intoxication prompted us to review our experience with this poison since 1980. Of 45 methanol intoxication patients treated in our ICU, CT scan was performed in 21, and brain hemorrhage was documented in six, thereby giving an incidence of at least six of 45 or 13.5%. Although hemorrhagic and nonhemorrhagic putamenal necrosis has been described from methanol poisoning previously, we postulate that heparinization during hemodialysis may contribute to brain hemorrhage complicating methanol poisoning and recommend the use of artificial kidneys with albumin-primed biocompatible membranes so that heparin administration during hemodialysis can be minimized.
Insights
Methanol poisoning can cause fatal brain hemorrhage, particularly in patients undergoing hemodialysis. Minimizing heparin use during dialysis may reduce this severe complication in methanol intoxication cases.
Area of Science:
- Neurology
- Toxicology
- Critical Care Medicine
Background:
- Methanol intoxication is a serious poisoning with potentially fatal outcomes.
- Brain hemorrhage is a recognized but not fully understood complication of methanol poisoning.
- Previous studies have described putamenal necrosis in methanol poisoning.
Purpose of the Study:
- To investigate the incidence of brain hemorrhage in methanol intoxication patients.
- To explore potential contributing factors to brain hemorrhage in methanol poisoning.
- To recommend strategies for mitigating this complication.
Main Methods:
- Retrospective review of 45 patients with methanol intoxication treated in an ICU from 1980 onwards.
- Analysis of CT scans and autopsy findings for evidence of brain hemorrhage.
- Correlation of brain hemorrhage with treatment modalities, including hemodialysis and heparinization.
Main Results:
- Five out of seven recently treated patients died within 72 hours.
- Brain hemorrhage was documented in 6 of 45 (13.5%) methanol intoxication patients.
- Two survivors had no visual or neurologic impairment; two deceased patients showed hemorrhagic brain necrosis.
Conclusions:
- Brain hemorrhage is a significant complication of methanol intoxication with a notable incidence.
- Heparinization during hemodialysis may contribute to the occurrence of brain hemorrhage in methanol poisoning.
- Utilizing artificial kidneys with albumin-primed biocompatible membranes could minimize heparin requirements and potentially reduce brain hemorrhage risk.