Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning: A Systematic Review and Consensus Statement
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Citações na Scopus
115
Tipo de produção
article
Data de publicação
2015
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
ROBERTS, Darren M.
YATES, Christopher
MEGARBANE, Bruno
WINCHESTER, James F.
MACLAREN, Robert
GOSSELIN, Sophie
NOLIN, Thomas D.
LAVERGNE, Valery
HOFFMAN, Robert S.
GHANNOUM, Marc
Autor de Grupo de pesquisa
Extracorporeal Treatments
Citação
CRITICAL CARE MEDICINE, v.43, n.2, p.461-472, 2015
Resumo
Objective: Methanol poisoning can induce death and ""disability. Treatment includes the administration of antidotes (ethanol or fomepizole and folic/folinic acid) and consideration of extracorporeal treatment for correction of acidemia and/or enhanced elimination. The Extracorporeal Treatments in Poisoning workgroup aimed to develop evidence-based consensus recommendations for extracorporeal treatment in methanol poisoning. Design and Methods: Utilizing predetermined methods, we conducted a systematic review of the literature. Two hundred seventy-two relevant publications were identified but publication and selection biases were noted. Data on clinical outcomes and dialyzability were collated and a two-round modified Delphi process was used to reach a consensus. Results: Recommended indications for extracorporeal treatment: Severe methanol poisoning including any of the following being attributed to methanol: coma, seizures, new vision deficits, metabolic acidosis with blood pH.7.15, persistent metabolic acidosis despite adequate supportive measures and antidotes, serum anion gap higher than 24 mmol/L; or, serum methanol concentration 1) greater than 700 mg/L (21.8 mmol/L) in the context of fomepizole therapy, 2) greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment 3) greater than 500 mg/L or 15.6 mmol/L in the absence of an alcohol dehydrogenase blocker; in the absence of a methanol concentration, the osmolal/ osmolar gap may be informative; or, in the context of impaired kidney function. Intermittent hemodialysis is the modality of choice and continuous modalities are acceptable alternatives. Extracorporeal treatment can be terminated when the methanol concentration is <200 mg/L or 6.2 mmol/L and a clinical improvement is observed. Extracorporeal Treatments in Poisoning inhibitors and folic/folinic acid should be continued during extracorporeal treatment. General considerations: Antidotes and extracorporeal treatment should be initiated urgently in the context of severe poisoning. The duration of extracorporeal treatment extracorporeal treatment depends on the type of extracorporeal treatment used and the methanol exposure. Indications for extracorporeal treatment are based on risk factors for poor outcomes. The relative importance of individual indications for the triaging of patients for extracorporeal treatment, in the context of an epidemic when need exceeds resources, is unknown. In the absence of severe poisoning but if the methanol concentration is elevated and there is adequate alcohol dehydrogenase blockade, extracorporeal treatment is not immediately required. Systemic anticoagulation should be avoided during extracorporeal treatment because it may increase the development or severity of intracerebral hemorrhage. Conclusion: Extracorporeal treatment has a valuable role in the treatment of patients with methanol poisoning. A range of clinical indications for extracorporeal treatment is provided and duration of therapy can be guided through the careful monitoring of biomarkers of exposure and toxicity. In the absence of severe poisoning, the decision to use extracorporeal treatment is determined by balancing the cost and complications of extracorporeal treatment to that of fomepizole or ethanol. Given regional differences in cost and availability of fomepizole and extracorporeal treatment, these decisions must be made at a local level.
Palavras-chave
acidosis, antidotes, consensus guidelines, Delphi process, dialysis, dialyzability, enhanced elimination, extracorporeal treatment, indications, intoxication, methanol, morbidity, mortality, poisoning, systematic review, triage
Referências
- Adanir T, 2005, EUR J ANAESTH, V22, P560, DOI 10.1017/S0265021505270941
- Adanir T, 2005, ANESTEZI DERGISI, V13, P127
- Akhtar J, 2008, CLIN TOXICOL, V46, P642
- Akhtar J, 2006, CLIN TOXICOL, V44, P714
- [Anonymous], 1946, ACTA MED SCAND, V125, P117
- Anseeuw K, 2008, EUR J EMERG MED, V15, P107, DOI 10.1097/MEJ.0b013e3282f3c13b
- Atkins D, 2004, BMJ-BRIT MED J, V328, P1490
- Barceloux DG, 2002, J TOXICOL-CLIN TOXIC, V40, P415
- Bebarta VS, 2006, AM J EMERG MED, V24, P725, DOI 10.1016/j.ajem.2006.03.004
- BENNETT IL, 1953, MEDICINE, V32, P431, DOI 10.1097/00005792-195312000-00002
- BERENDT RC, 1987, J CRIT CARE, V2, P181, DOI 10.1016/0883-9441(87)90005-0
- BERGERON R, 1982, NEW ENGL J MED, V307, P1528
- Brent J, 2001, NEW ENGL J MED, V344, P424, DOI 10.1056/NEJM200102083440605
- Bronstein AC, 2012, CLIN TOXICOL, V50, P911, DOI 10.3109/15563650.2012.746424
- Burns AB, 1998, AM J EMERG MED, V16, P538, DOI 10.1016/S0735-6757(98)90014-6
- Burns MJ, 1997, ANN EMERG MED, V30, P829, DOI 10.1016/S0196-0644(97)70060-X
- CHEW WB, 1946, JAMA-J AM MED ASSOC, V130, P61, DOI 10.1001/jama.1946.02870020005002
- Coulter CV, 2011, CLIN TOXICOL, V49, P900, DOI 10.3109/15563650.2011.630320
- Coulter CV, 2011, CLIN PHARMACOKINET, V50, P245, DOI 10.2165/11584250-000000000-00000
- EKINS BR, 1985, WESTERN J MED, V142, P337
- Ellsworth H, 2011, CLIN TOXICOL, V49, P515
- Elwell RJ, 2004, AM J EMERG MED, V22, P126, DOI 10.1016/j.ajem.2003.12.017
- Fadnes H O, 1985, Lakartidningen, V82, P116
- Fitch K, 2011, RAND UCLA APPROPRIAT
- FRENIA ML, 1993, ANN EMERG MED, V22, P1919, DOI 10.1016/S0196-0644(05)80424-X
- Ghannoum M, 2014, SEMIN DIALYSIS, V27, P395, DOI 10.1111/sdi.12237
- Ghannoum M, 2011, ADV CHRONIC KIDNEY D, V18, P160, DOI 10.1053/j.ackd.2011.01.008
- GONDA A, 1978, AM J MED, V64, P749, DOI 10.1016/0002-9343(78)90513-2
- Graw M, 2000, ARCH TOXICOL, V74, P313, DOI 10.1007/s002040000107
- Hantson P, 2005, HUM EXP TOXICOL, V24, P55, DOI 10.1191/0960327105ht503oa
- Hassanian-Moghaddam H, 2007, HUM EXP TOXICOL, V26, P583, DOI 10.1177/0960327106080077
- Hassanian-Moghaddam H, 2013, P ASIA PACIFIC ASS M, V49
- Hovda KE, 2008, HUM EXP TOXICOL, V27, P539, DOI 10.1177/0960327108095992
- Hovda KE, 2005, J INTERN MED, V258, P181, DOI 10.1111/j.1365-2796.2005.01521.x
- Hovda KE, 2005, CLIN TOXICOL, V43, P221, DOI 10.1081/CLT-200058936
- Hovda KE, 2004, INTENS CARE MED, V30, P1842, DOI 10.1007/s00134-004-2373-7
- Hunderi Odd Helge, 2004, Tidsskr Nor Laegeforen, V124, P3199
- Hunderi OH, 2006, SCAND J UROL NEPHROL, V40, P70, DOI 10.1080/00365590500190755
- Isaacs R, 1920, J AMER MED ASSOC, V75, P718
- Iseki Ken, 2009, Chudoku Kenkyu, V22, P238
- JACOBSEN D, 1982, ACTA MED SCAND, V212, P5
- Jacobsen D, 1997, J TOXICOL-CLIN TOXIC, V35, P127, DOI 10.3109/15563659709001182
- JACOBSEN D, 1983, SCAND J CLIN LAB INV, V43, P377
- JACOBSEN D, 1983, ACTA MED SCAND, V214, P409
- JACOBSEN D, 1986, MED TOXICOL ADV DRUG, V1, P309, DOI 10.1007/BF03259846
- KANE RL, 1968, ARCH ENVIRON HEALTH, V17, P119, DOI 10.1080/00039896.1968.10665199
- Kerns W, 2002, J TOXICOL-CLIN TOXIC, V40, P137, DOI 10.1081/CLT-120004401
- Kostic MA, 2003, J TOXICOL-CLIN TOXIC, V41, P793, DOI 10.1081/CLT-120025344
- Krasowski MD, 2012, BMC CLIN PATHOL, V12, DOI 10.1186/1472-6890-12-1
- Kute VB, 2012, SAUDI J KIDNEY DIS T, V23, P37
- Lavergne V, 2012, CLIN TOXICOL, V50, P403, DOI 10.3109/15563650.2012.683436
- Liu JJ, 1998, J TOXICOL-CLIN TOXIC, V36, P175, DOI 10.3109/15563659809028937
- Lynd LD, 2008, BMC EMERG MED, V8, DOI 10.1186/1471-227X-8-5
- MAHIEU P, 1989, HUM TOXICOL, V8, P135, DOI 10.1177/096032718900800209
- MARCAURELE J, 1960, J CLIN INVEST, V39, P802, DOI 10.1172/JCI104098
- MCCORMICK MJ, 1990, ANN EMERG MED, V19, P639, DOI 10.1016/S0196-0644(05)82467-9
- MCCOY HG, 1979, AM J MED, V67, P804, DOI 10.1016/0002-9343(79)90738-1
- MCMARTIN KE, 1980, AM J MED, V68, P414, DOI 10.1016/0002-9343(80)90113-8
- MEATHERALL R, 1990, CLIN CHEM, V36, P2004
- Megarbane B, 2001, INTENS CARE MED, V27, P1370, DOI 10.1007/s001340101011
- Meyer RJ, 2000, NEW ZEAL MED J, V113, P11
- Nelson L., 2010, GOLDFRANKS TOXICOLOG
- NOLLASALAS J, 1995, MED CLIN-BARCELONA, V104, P121
- OSTERLOH JD, 1986, ANN INTERN MED, V104, P200, DOI 10.7326/0003-4819-104-2-200
- Paasma R, 2007, CLIN TOXICOL, V45, P152, DOI 10.1080/15563650600956329
- Paasma R, 2012, CLIN TOXICOL, V50, P823, DOI 10.3109/15563650.2012.728224
- Paasma Raido, 2009, BMC Clin Pharmacol, V9, P5, DOI 10.1186/1472-6904-9-5
- PALATNICK W, 1995, ANN EMERG MED, V26, P202, DOI 10.1016/S0196-0644(95)70152-4
- PFISTER AK, 1966, J AMER MED ASSOC, V197, P1041
- PHANG PT, 1988, CRIT CARE MED, V16, P137, DOI 10.1097/00003246-198802000-00008
- ROE O, 1950, Q J STUD ALCOHOL, V11, P107
- ROEGGLA G, 1993, AM FAM PHYSICIAN, V48, P731
- SCHREINER GE, 1970, T AM SOC ART INT ORG, V16, P544
- Sharma R, 2012, OPTOMETRY VISION SCI, V89, P178, DOI 10.1097/OPX.0b013e31823ee128
- Sivilotti M, 1998, CLIN TOXICOL PHILA, V36, P451
- Spillum BJ, 2003, CLIN TOXICOL, V41, P397
- SWARTZ RD, 1981, MEDICINE, V60, P373, DOI 10.1097/00005792-198109000-00005
- Teo S. K., 1996, Singapore Medical Journal, V37, P485
- Unsal A, 2012, NEPHRO UROL MON, V4, P366
- Vares M, 2012, MED INTENSIVA, V36, P379, DOI 10.1016/j.medin.2011.09.013
- Wallace EA, 2009, CLIN TOXICOL, V47, P239, DOI 10.1080/15563650802498781
- Waring WS, 2010, CLIN TOXICOL, V48
- Zakharov S, 2014, KIDNEY INT, V86, P199, DOI 10.1038/ki.2014.60