Almost 'walked with death' because of methanol poisoning

Methanol poisoning can be fatal if not detected early. Headache, drowsiness, blurred vision… are all signs of poisoning but are easily overlooked.

Fatal if not detected early

Patient NTH (49 years old, Ha Tinh) was admitted to the hospital at 6:45 am on December 31, 2015 due to coma. The patient had a history of high blood pressure (but not treated) and kidney stones. About 3 days before and after admission, the patient drank a large amount of alcohol many times. At about 5 pm on December 30, 2015, the patient experienced blurred vision, which gradually increased, and quickly lost consciousness. The patient was admitted to Nghe An General Hospital in a deep coma (GCS 5 points), deep rapid breathing, pulse 100 times/minute, blood pressure 100/60 mmHg, dilated pupils of 5 mm on both sides, negative pupillary light reflex, no localized paralysis. The patient was intubated and immediately ventilated. CT scan of the brain showed no lesions. Blood test showed severe metabolic acidosis (pH: 7.106; PCO2: 15.2 mmHg; PO2: 458.1 mmHg; HCO3-: 7.7 mmol/l). The patient was preliminarily diagnosed with hepatic coma and transferred to the Emergency Department A9, Bach Mai Hospital.

Through examination, assessment and based on the test results that Nghe An General Hospital had done, the doctors of the A9 Emergency Department immediately thought of alcohol poisoning, or more precisely, Methanol poisoning. The blood Methanol test, which came back a few hours later, was 107 mg/dl.

With a state of deep coma, dilated pupils on both sides, severe metabolic acidosis... the patient has a very high risk of death. Immediately after thinking that the patient had methanol poisoning, the doctors treated the patient with 4.2% sodium bicarbonate intravenously, continuous blood filtration...

Talking about this phenomenon, Dr. Luong Quoc Chinh, A9 Emergency Department, Bach Mai Hospital said: The only type of alcohol for drinking is called ethyl alcohol or ethanol, which is produced according to a separate process and the product must meet food quality standards. There are also many other types of alcohol, but they are highly toxic, such as methanol. Methanol is produced industrially, as the end product of many production processes, from the transformation of many types of fruit, from the decomposition of waste... Methanol has many different applications in industry such as being used to make paint, to clean varnish, to be used as a solvent... However, methanol must absolutely not be used as food alcohol like ethanol.

Patient NTH is undergoing continuous dialysis at Emergency Department A9, Bach Mai Hospital.

Most deaths from methanol poisoning are due to suicide or the use of methanol as a substitute for ethanol... In adults, methanol poisoning at a dose of 8g (1ml of 100% solution) can cause blindness, poisoning at a dose of 10g (30ml of 40% solution) can cause death. In children, methanol poisoning at a dose of 0.25ml/kg has caused blindness and 0.5ml/kg has caused death (100% solution). Before causing poisoning, methanol is metabolized to formaldehyde and then oxidized to formic acid (formate). High concentrations of formic acid in the blood inhibit mitochondrial cytochrome oxidase in cells, causing cellular hypoxia, severe metabolic acidosis, optic nerve damage and retinal damage. In addition, methanol causes central nervous system depression, vasodilation, hypotension and reduced cardiac output.

Early signs of alcohol poisoning

Dr. Chinh said that symptoms of methanol poisoning usually appear within 30 minutes of drinking but can be later, depending on the amount the patient drank, whether the patient drank ethanol (symptoms appear later) and the patient's folate status. There are usually two stages, the hidden stage (the first few hours to 30 hours) and the stage of obvious poisoning that follows. Because the initial symptoms are often hidden and mild (mild nerve inhibition, sedation, numbness), they are often overlooked by the patient or not detected by young children.

Neurological problems: Upon arrival at the hospital, patients are often conscious and complain of headache, dizziness, then forgetfulness, restlessness, mania, lethargy, confusion, coma, and convulsions.

Eye detection: Initially no symptoms, then blurred vision, photophobia, scotoma, eye pain, diplopia, central scotoma, decreased or loss of vision, visual hallucinations (glare, dancing dots, tunnel vision, etc.). Pupils react poorly to light, fundus examination shows optic disc congestion, then retinal edema spreads along the blood vessels to the center of the fundus, blood vessels congest, optic disc edema, retinal hemorrhage. Fixed dilated pupils are a sign of severe poisoning and a poor prognosis.

Vital signs: Tachycardia, rapid and deep breathing (kussmaul respiration), blood pressure is usually normal until death. Before current specific treatments, death usually occurred due to respiratory arrest.

To save the poisoned person in time, Dr. Chinh advises: When a patient is poisoned with alcohol, especially if there is a disturbance of consciousness, the basic first aid principle is to ensure a clear airway by keeping the patient's head elevated and in a safe tilted position. Every few hours, the patient must be woken up. If the patient is awake and can eat and drink, then feed him/her porridge... to avoid hypoglycemia. If the patient is not awake, has a lot of congestion in the throat, is breathing rapidly and deeply, or even has convulsions... then keep the patient in a position where the head is elevated and lying safely on his/her side, then quickly call for help, call an ambulance to handle the situation and take the patient to the hospital. If the patient wakes up but has a severe headache, dizziness and blurred vision, photophobia, blind spots, eye pain, double vision, central blind spots, decreased or lost vision, hallucinations... then he/she needs to be taken to the hospital for examination.

“Drinking too much alcohol causes many harmful effects on human health. Therefore, you should control and moderate your alcohol consumption. If you experience symptoms such as headache, dizziness, blurred vision, etc. after a few hours of drinking, you should go to the hospital immediately,” warned Dr. Luong Quoc Chinh.

According to VietQ.vn