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      Association between acute methanol poisoning and subsequent mortality: a nationwide study in Taiwan

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          Abstract

          Background

          Methanol poisoning (MP) often causes acute mortality and morbidities; however, the association between MP and subsequent mortality has not been well studied.

          Methods

          We conducted a nationwide population-based cohort study by identifying 621 participants with MP from the Nationwide Poisoning Database and 6210 participants without MP from the Longitudinal Health Insurance Database 2000 by matching the index date at a 1:10 ratio between 1999 and 2012. Comparison of the mortality rate between the two cohorts was performed by following up until 2013.

          Results

          A total of 249 (40%) participants with MP and 154 (2.5%) participants without MP died during the follow-up ( p < 0.001). Statistic analysis showed that participants with MP had a higher risk for mortality than did the participants without MP (adjusted hazard ratio [AHR]: 13.48; 95% confidence interval [CI]: 10.76–16.88). The risk of mortality was highest in the first 6 months after MP (AHR: 480.34; 95% CI: 117.55–1962.75). Hypertension, chronic obstructive pulmonary disease, liver disease, malignancy, drug abuse, and lower monthly income also predicted mortality.

          Conclusions

          MP was associated with increased subsequent mortality. Close follow-up for comorbidity control and socioeconomic assistance are suggested for patients with MP.

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          Most cited references17

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          Adolescent alcohol use: risks and consequences.

          The aim of the study was to summarize results of recent epidemiological research on adolescent alcohol use and its consequences, to outline the risk factors for drinking in adolescents and to consider effective treatment and preventative interventions.
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            Toxic alcohol ingestions: clinical features, diagnosis, and management.

            Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.
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              Methanol outbreak in Norway 2002-2004: epidemiology, clinical features and prognostic signs.

              Knowledge on methanol poisoning does mainly come from clinical studies. We therefore report epidemiological, clinical and prognostic features from the large methanol outbreak in Norway in 2002-2004 where the new antidote fomepizole was the primary antidote in use. Combined prospective and retrospective case series study of 51 hospitalized patients who were confirmed poisoned with methanol, of whom nine died. In addition, eight patients died outside hospital. Most patients were admitted in a late stage and because of symptoms. Treatment consisted of alkali, fomepizole (71%) and haemodialysis (73%). The median serum methanol was 25.0 mmol L-1 (80 mg dL-1) (range 3.1-147.0 mmol L-1), median pH was 7.20 (6.50-7.50), and median base deficit 22 mmol L-1 (range 0-31). The most frequent clinical features reported were visual disturbances (55%), dyspnoea (41%), and gastrointestinal symptoms (43%). Twenty-four per cent were comatose on admission, of whom 67% died. There was a trend towards decreasing pCO2 with decreasing pH amongst the patients surviving. The opposite trend was demonstrated in the dying; the difference was highly significant by linear regression analyses (P 28 mmol L-1) upon admission were strong predictors of poor outcome. Early admission and ability of respiratory compensation of metabolic acidosis was associated with survival.
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                Author and article information

                Contributors
                bybarian@gmail.com
                ho.c.hank@gmail.com
                laura751111986@hotmail.com
                chenjiannhwa@yahoo.com.tw
                hjlin52@gmail.com
                400002@mail.chimei.org.tw
                +886-6-281-2811 , nych2525@gmail.com
                +886-6-281-2811 , chienchenghuang@yahoo.com.tw
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                7 August 2018
                7 August 2018
                2018
                : 18
                : 985
                Affiliations
                [1 ]ISNI 0000 0004 0627 9786, GRID grid.413535.5, Department of Emergency Medicine, , Cathay General Hospital, ; Taipei, Taiwan
                [2 ]ISNI 0000 0004 0572 9255, GRID grid.413876.f, Department of Medical Research, , Chi Mei Medical Center, ; Tainan, Taiwan
                [3 ]ISNI 0000 0004 0634 2255, GRID grid.411315.3, Department of Pharmacy, , Chia Nan University of Pharmacy and Science, ; Tainan, Taiwan
                [4 ]ISNI 0000 0004 1937 1063, GRID grid.256105.5, Fu Jen Catholic University School of Medicine, ; Taipei, Taiwan
                [5 ]ISNI 0000 0004 0572 9255, GRID grid.413876.f, Department of Emergency Medicine, , Chi-Mei Medical Center, ; 901 Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
                [6 ]ISNI 0000 0004 0532 2914, GRID grid.412717.6, Department of Biotechnology, , Southern Taiwan University of Science and Technology, ; Tainan, Taiwan
                [7 ]ISNI 0000 0000 9337 0481, GRID grid.412896.0, Department of Emergency Medicine, , Taipei Medical University, ; Taipei, Taiwan
                [8 ]ISNI 0000 0004 0532 3255, GRID grid.64523.36, Department of Environmental and Occupational Health, , College of Medicine, National Cheng Kung University, ; Tainan, Taiwan
                [9 ]ISNI 0000 0004 0532 2914, GRID grid.412717.6, Department of Senior Services, , Southern Taiwan University of Science and Technology, ; Tainan, Taiwan
                [10 ]ISNI 0000 0004 0572 9255, GRID grid.413876.f, Department of Geriatrics and Gerontology, , Chi-Mei Medical Center, ; Tainan, Taiwan
                [11 ]ISNI 0000 0004 0572 9255, GRID grid.413876.f, Department of Occupational Medicine, , Chi-Mei Medical Center, ; Tainan, Taiwan
                Author information
                http://orcid.org/0000-0003-3595-2952
                Article
                5918
                10.1186/s12889-018-5918-3
                6081913
                30086726
                cc530f3d-d726-44b0-a4ad-096a3127ecd5
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 March 2018
                : 30 July 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100006578, Chi Mei Medical Center;
                Award ID: CMFHR10683
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                methanol,poisoning,intoxication,mortality
                Public health
                methanol, poisoning, intoxication, mortality

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