A Retrospective Analysis of a Methanol Poisoning Outbreak in an Indian Tertiary Care Hospital during the COVID-19 Era: A Pandemic within a Pandemic

Abstract

Background: Methanol poisoning is associated with high morbidity and mortality, due to its toxic metabolites namely formaldehyde and formic acid. Though explicit treatment guidelines exist but management becomes an arduous task when a cluster of cases present in resource limited settings. We describe here an outbreak of methanol poisoning during COVID 19 pandemic, the challenges faced and the outcome.Objectives: To review the clinical manifestations, biochemical parameters, management and outcome of patients of methanol poisoningMethodology: A retrospective analysis of methanol poisoning patients presenting to our hospital during an outbreak.Results: A total of 108 patients presented to our center over a span of 13 days. All had allegedly consumed adulterated alcohol 12 to 96 hours prior to admission. 41had expired en-route to hospital, 20 expired within 6 hours of presentation and 8 were intubated. Among survivors, the most common complaint was visual blurring (n=31) followed by neurological symptoms (n=27). The mean pH and anion gap were 7.06 and 27.2 respectively at presentation and 7.38 and 8.0 respectively on discharge. 30 patients underwent hemodialysis to remove the toxic alcohol and its metabolites. All patients with ocular involvement received injection methylprednisolone 500 mg for 3 days. The overall mortality was 67.5%.Conclusion: Methanol poisoning needs to be recognized early and managed emergently. Delay in seeking medical care substantially increases mortality. In case of inaccessibility to fomepizole and ethanol, dialysis has a pivotal role in management. Methylprednisolone therapy should be considered in all patients with visual complaints to reduce complications.

Keywords

• methanol
• outbreak
• acidosis
• hemodialysis