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The safety of ethanol infusions for the treatment of methanol or ethylene glycol intoxication: an observational study

Published online by Cambridge University Press:  11 May 2015

Mary Kate Wedge ,
Sabrina Natarajan ,
Christel Johanson ,
Rakesh Patel  and
Salmaan Kanji
Mary Kate Wedge
Affiliation:
Department of Pharmacy, Saint John Regional Hospital, Saint John, NB
Sabrina Natarajan*
Affiliation:
Department of Pharmacy, The Ottawa Hospital, Ottawa, ON
Christel Johanson
Affiliation:
Department of Pharmacy, The Ottawa Hospital, Ottawa, ON
Rakesh Patel
Affiliation:
Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, ON Division of General Internal Medicine, The Ottawa Hospital, Ottawa, ON
Salmaan Kanji
Affiliation:
Department of Pharmacy, The Ottawa Hospital, Ottawa, ON Division of General Internal Medicine, The Ottawa Hospital, Ottawa, ON The Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, ON
*
Department of Pharmacy, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6; snatarajan@ottawahospital.on.ca.

Abstract

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Background:

Methanol or ethylene glycol ingestion may result in significant morbidity or death without prompt treatment. Despite traditional and widespread use of intravenous ethanol as an antidote, its safety is not well described. An evaluation of the safety and ease of titrating ethanol infusions is necessary given the availability of an alternative antidote.

Objective:

To evaluate the safety and ease of titrating ethanol infusions for the treatment of methanol or ethylene glycol ingestion.

Methods:

We reviewed the hospital records of adults treated with ethanol at The Ottawa Hospital for methanol or ethylene glycol ingestion over a 9-year period. Using a standardized case report form, a single reviewer identified prespecified adverse events that developed after the start of ethanol therapy and classified dose adjustments during ethanol therapy as appropriate or inappropriate based on a priori criteria.

Results:

Forty-nine cases of methanol or ethylene glycol ingestion treated with ethanol were included in the analysis, of which 45 underwent hemodialysis, 38 were admitted to the intensive care unit, and 4 died. At least one adverse event was identified in 45 (92%) cases, including 35 (71%) with agitation requiring chemical or physical restraints and 10 (20%) with a depressed level of consciousness treated with intubation. The median number of ethanol concentration measurements per treatment course was 6 (range 0–24), of which only 27% were within the target range of 22 to 30 mmol/L and 47% were below. When measured concentrations were outside the target, the adjustment in ethanol dosing (or lack thereof) was deemed inappropriate 59% of the time, including 69% of the time during hemodialysis.

Conclusion:

Based on actual practice in a large academic centre, adverse events occur frequently with intravenous ethanol infusions, and ethanol titration is inefficient. The safety profile and therapeutic drug monitoring considerations for ethanol should be considered when choosing an antidote for methanol or ethylene glycol ingestion.

Keywords

ethanolethylene glycolfomepizolemethanol
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 5 , September 2012 , pp. 283 - 289
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

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