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Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

S. Zakharov, D. Pelclova, T. Navratil, J. Belacek, I. Kurcova, O. Komzak, T. Salek, J. Latta, R. Turek, R. Bocek, C. Kucera, JA. Hubacek, Z. Fenclova, V. Petrik, M. Cermak, KE. Hovda,

. 2014 ; 86 (1) : 199-207. [pub] 20140312

Language English Country United States

Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc16021100

During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates.

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$a During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates.
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$a Pelclova, Daniela $u Department of Occupational Medicine, Toxicological Information Center, General University Hospital and First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
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$a Navratil, Tomas $u J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i., Prague, Czech Republic.
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$a Belacek, Jaromir $u Institute of Biophysics and Informatics of First Faculty of Medicine of Charles University in Prague, General University Hospital, Prague, Czech Republic.
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$a Kurcova, Ivana $u Department of Toxicology, Institute of Forensic Medicine and Toxicology, General University Hospital in Prague and of the First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
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$a Salek, Tomas $u Department of Clinical Biochemistry, Tomas Bata Regional Hospital in Zlin, Zlin, Czech Republic.
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