급성 독성 알코올 중독에 대한 후향적 분석
A retrospective analysis of toxic alcohol poisoning
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning. Methods: This single-center retrospective observational study included patients with toxic alcohol poi soning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poi soning from January 2004 to June 2023 were selected for the study using diagnostic codes. Results: Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 pa tients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were morelikely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were morelikely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23mmol/L, p=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, p=0.007)were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcoholdehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6[54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-sig nificantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%],p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, onepatient was left with permanent vision damage. Conclusion: Because these are uncommon types of poisoning and the clinical presentation is difficult torecognize early, healthcare providers should be familiar with toxic alcohol types and screen for them toensure proper diagnosis and treatment.
Abstract
Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning. Methods: This single-center retrospective observational study included patients with toxic alcohol poi soning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poi soning from January 2004 to June 2023 were selected for the study using diagnostic codes. Results: Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 pa tients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were morelikely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were morelikely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23mmol/L, p=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, p=0.007)were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcoholdehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6[54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-sig nificantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%],p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, onepatient was left with permanent vision damage. Conclusion: Because these are uncommon types of poisoning and the clinical presentation is difficult torecognize early, healthcare providers should be familiar with toxic alcohol types and screen for them toensure proper diagnosis and treatment.
참고문헌 (22)
- Kraut JA, "Toxic alcohol ingestions : clinical features, diagnosis, and management", Clin J Am Soc Nephrol, 3, pp.208~225 (2008)[DOI]
- Mahieu P, "Predictors of methanol intoxication with unfavourable outcome", Hum Toxicol, 8, pp.135~137 (1989)[DOI]
- Jacobsen D, "Methanol and ethylene glycol poisonings : mechanism of toxicity, clinical course, diagnosis and treatment", Med Toxicol, 1, pp.309~334 (1986)[DOI]
- Liu JJ, "Prognostic factors in patients with methanol poisoning", J Toxicol Clin Toxicol, 36, pp.175~181 (1998)[DOI]
- Hylander B, "Prognostic factors and treatment of severe ethylene glycol intoxication", Intensive Care Med, 22, pp.546~552 (1996)[DOI]
- Gallagher N, "The Diagnosis and management of toxic alcohol poisoning in the emergency department : a review article", Adv J Emerg Med, 3, pp.e28~ (2019)[DOI]
- Rhee NG, "Clinical review of toxic alcohol poisoning cases in Korea", J Korean Soc Clin Toxicol, 10, pp.15~21 (2012)
- 송재우, "급성 에틸렌글리콜 중독 환자의 치료 방법으로서 체외제거법 적용", 대한응급의학회지, 28(1), pp.109~116 (2017), 대한응급의학회
- Kim SI, "Measurement of volume of a swallow for liquid swallowing in healthy young adults", J Korean Soc Clin Toxicol, 11, pp.114~118 (2013)
- Moon JM, "Acute endosulfan poisoning : a retrospective study", Hum Exp Toxicol, 28, pp.309~316 (2009)[DOI]
- Khwaja A, "KDIGO clinical practice guidelines for acute kidney injury", Nephron Clin Pract, 120, pp.c179~84 (2012)[DOI]
- Barceloux DG, "American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning", J Toxicol Clin Toxicol, 40, pp.415~446 (2002)[DOI]
- McQuade DJ, "Challenges in the diagnosis of ethylene glycol poisoning", Ann Clin Biochem, 51(Pt 2), pp.167~178 (2014)[DOI]
- Krasowski MD, "A retrospective analysis of glycol and toxic alcohol ingestion : utility of anion and osmolal gaps", BMC Clin Pathol, 12, pp.1~ (2012)[DOI]
- Kraut JA, "The serum anion gap in the evaluation of acid-base disorders : what are its limitations and can its effectiveness be improved?", Clin J Am Soc Nephrol, 8, pp.2018~2024 (2013)[DOI]
- A S Sagar, "Lactate gap as a tool in identifying ethylene glycol poisoning", BMJ Case Reports, pp.bcr~2018 (2018), BMJ[DOI]
- Kraut JA, "Toxic alcohols", N Engl J Med, 378, pp.270~280 (2018)[DOI]
- Wiles D, "Comment on treatment methods for ethylene glycol intoxication", Neth J Med, 72, pp.383~384 (2014)
- Brent J, "Fomepizole for ethylene glycol and methanol poisoning", N Engl J Med, 360, pp.2216~2223 (2009)[DOI]
- Heather Miller, "American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning", Journal of Toxicology: Clinical Toxicology, 37(5), pp.537~560 (1999), Informa UK Limited[DOI]
- Roberts DM, "Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning : a systematic review and consensus statement", Crit Care Med, 43, pp.461~472 (2015)[DOI]
- Grufferman S, "Methanol poisoning complicated by myoglobinuric renal failure", Am J Emerg Med, 3, pp.24~26 (1985)[DOI]