Published online Aug 7, 2020. doi: 10.5492/wjccm.v9.i3.54
Peer-review started: April 6, 2020
First decision: June 8, 2020
Revised: June 8, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 7, 2020
Processing time: 121 Days and 19 Hours
Mass methanol poisonings are challenging, especially in regions with no preparedness, management guidelines and available antidotes.
Six Ukrainian patients were referred to our emergency department in Cairo, Egypt several hours after drinking an alcoholic beverage made of 70%-ethanol disinfectant bought from a local pharmacy. All patients presented with severe metabolic acidosis and visual impairments. Two were comatose. Management was based on the clinical features and chemistry tests due to deficient resources for methanol leveling. No antidote was administered due to fomepizole unavailability and the difficulties expected to obtain ethanol and safely administer it without concentration monitoring. One patient died from multiorgan failure, another developed blindness and the four other patients rapidly improved.
This methanol poisoning outbreak strongly highlights the lack of safety from hazardous pharmaceuticals sold in pharmacies and limitations due to the lack of diagnostic testing, antidote availability and staff training in countries with limited-resources such as Egypt.
Core tip: Mass methanol poisoning with unpredictable risk assessment represents a major threat in developing countries. This work reports a clinical series with patients' features and outcome, describes the investigations to identify rapidly the involved causative agent (here, a homemade beverage made with alcoholic disinfectant) and discusses the observed insufficiencies to improve hospital preparedness in case of methanol poisoning outbreak.