Lessons from a methanol poisoning outbreak in Egypt: Six case reports

Table 1 Clinical, biological, management and outcome data in six methanol-poisoned patients during an outbreak in Egypt

	Patient 1		Patient 2	Patient 3	Patient 4	Patient 5	Patient 6
Clinical parameters on admission
Age in yr	41	47		41	46	42	42
Glasgow coma score	3	3		15	15	15	15
Respiratory rate as /min	32	30		26	29	23	18
Systolic/diastolic blood pressure in mmHg	80/60	60/40		110/70	110/80	100/80	150/100
Pupils	Dilated	Dilated		Dilated	Dilated	Dilated	Dilated
Repeated seizures	+	+		-	-	-	-
Ophthalmological examination	-	Diminished visual acuity bilaterally with diminished visual field for follow-up		Diminished visual acuity bilaterally for follow-up	Diminished visual acuity bilaterally for follow-up	Diminished visual acuity bilaterally for follow-up	Hand motion by the right eye and light perception by the left eye
Opthalmoscopy	Bilateral hyperemic swollen optic discs with flame-shaped shadow along superior arcade	Bilateral hyperemic optic discs with pale vassal rim		Bilateral hyperemic optic discs with peripapillary nerve fiber layer edema	Bilateral mild disc pallor and retinal edema	Bilateral pale swollen optic discs with superior and inferior retinal nerve fiber layer swelling	Bilateral disc pallor with normal retina
Biological parameters on admission
Arterial pH	6.80	6.80		7.18	7.03	7.07	7.36
HCO3- concentration in mmol/L	4.2	4.5		9.7	8.2	4.3	20.9
PaCO2 in mmHg	27	22		26	31	15	37
Serum creatinine in mg/dL	1.1	1.6		4.1	1.0	0.9	1.1
Blood urea nitrogen in mg/dL	26	44		26	26	31	36
AST/ALT	80/60	31/15		36/38	43/57	28/20	28/24
Hemoglobin in g/dL	15.0	15.0		13.2	15.0	15.6	14.0
Platelets in G/L	150	250		226	202	314	150
White blood cells in G/L	8.1	22.7		13.6	8.3	14.3	6.1
Management
Sodium bicarbonates	+	+		+	+	+	+
Thiamin at 400 mg/d, IV	+	+		+	+	+	+
Leucovorin at 200 mg/d, IV	+	+		+	+	+	+
Methylprednisolone at 400 mg/d, IV	+	+		-	-	+	+
Diazepam at 30 mg/d, IV	+	+		-	-	-	-
Hemodialysis 2-h session	One session	One session /d during 4 d		One session /d during 2 d	One session	One session	One session /d during 2 d
Mechanical ventilation	+	+		-	-	-	-
Vasopressor, norepinephrine	+	-		-	-	-	-
Outcome
Outcome	Multiorgan failure and death	Disorientation, abnormal behavior, Diminished visual acuity		Full orientation, Pneumonia, Diminished visual acuity	Full orientation, Diminished visual acuity	Full orientation, Diminished visual acuity	Full orientation, Blindness
ICU discharge	Day 1	Day 7		Day 3	Day 3	Day 3	Day 5
Risk score, predicted risk of death1	Risk E, 83%	Risk D, 50%		Risk A, 5%	Risk A, 5%	Risk A, 5%	Risk A, 5%

¹Based on the risk assessment chart for the evaluation of outcome using admission parameters including coma onset, arterial pH and PaCO₂, according to Paasma et al[29].

Table 2 Risk assessment for the rapid evaluation of outcome based on admission parameters, adapted from Paasma et al[29]

Risk group	Coma	Arterial pH	PaCO2	Death risk
A	No	≥ 7.00	-	5%
B	No	6.74-6.99	-	10%
C	No	< 6.74	-	25%
D	Yes	6.74-6.99	< 3.07	50%
E	Yes	6.74-6.99	≥ 3.07	83%
F	Yes	< 6.74	-	89%

Determination of the risk group of 1 patient on admission requires the combination of all conditions for the three parameters.