Methanol poisoning needs prompt treatment, early dialysis

Twenty-six people from Malvani in Malad were admitted to Nair hospital from June 18 to 23 for methanol poisoning. All had consumed 150-250ml of liquor six to 24 hours prior to admission. Out of these, seven who were very critical were transferred to the Medical Intensive Care Unit. A majority of them had blurring of vision on admission. All of them had headache, chest discomfort and giddiness, along with severe acidosis (bicarbonate levels ranging from as low as 1 to 7 (normal being 18 to 24).

We treated them with ethyl alcohol (via ryles tube) and sodium bicarbonate intravenously, a standard treatment for methanol poisoning. Thirteen patients received haemodialysis (11 required only one session and two required two sessions each), which is again a standard practice to remove formic acid — a metabolic product of methanol.

All patients also received adequate intravenous fluids and were monitored round the clock. We also subjected them to investigations and ophthalmic examinations to rule out optic nerve damage.

Out of those admitted, 10 died and 13 recovered, with no residual visual deficit. One patient, who is otherwise stable, has suffered from loss of vision, while two are still in critical care unit. None of the patients had any neurological complications. However, late complications, such as rigidity (stiffness of the body) and tremors, which are Parkinsonian features, are known to occur in some patients a couple of months after exposure to methanol.

Hence, patients need to be followed up on for a period of time for these symptoms.

Patients of methanol poisoning should be detected and treated promptly and receive early dialysis, which would be life-saving. This is because if not treated promptly, methanol is metabolised to formic acid which is responsible for the visual symptoms and circulatory collapse, leading to death, and delayed neurological complications in survivors. Prompt dialysis removes the formic acid which is responsible for all the toxic effects of methanol poisoning.

Dr Mala V Kaneria
Prof and unit head, Department of Medicine
Nair Hospital