Methanol poisoning Czech Republic Ibrahim Ali

27 people in Czech Republic and 4 people in Poland dead Similar case in Estonia, 2001, 68 people dead, 43 disabled Prohibition era in the USA (1920) - death toll in the thousands

Methanol CH 3 OH - Colourless, flammable liquid with a slightly alcoholic smell Used as a feedstock, fuel, solvent, antifreeze Used to fortify illicit spirits (moonshine)

Toxicity Highly toxic to humans via two mechanisms Median lethal dose is 1–2 mL/kg of pure methanol (estimated 4 shots at 40%)

Mechanism CNS depression  Similar to ethanol: decreased rate of breathing (bradypnoea), decreased heart rate (bradycardia), and loss of consciousness leading to coma and eventually death. Due to similarity to ethanol’s effect on the body, methanol poisoning is not suspected until the patient sees a “snow storm”, where the visual apparatus has already been damaged

Metabolism to formic acid  Inhibition of cytochrome c oxidase

First set of symptoms Initial inebriation – especially if ethanol is also ingested h delay, then acidosis sets in and the second set of symptoms arise

Second set of symptoms CNS - inebriation progressing to coma, convulsions Retinal - blurred vision, photophobia, visual acuity loss, dilated non-reactive pupils, optic nerve hyperaemic - becoming oedematous GIT - nausea, vomiting Cardiac - tachycardia, hypertension progressing to hypotension and cardiogenic shock Respiratory - tachypnoea

Treatment Stabilising airway, breathing and circulation, limiting acidosis and reducing uptake of and removing methanol Traditionally the use of ethanol has been the basis of treatment however, where available, 4-Methyl pyrazole (fomepizole) should be used first Haemodialysis

Prognosis Depending on severity of exposure Permanent optic nerve damage occurs in 25% of survivors with permanent blindness/visual disturbance Hypotension Acidosis Coma Death However, with early detection and intervention, the survival rate is generally quite good.

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