OBJECTIVE: During an outbreak of mass methanol poisonings in the Czech Republic in 2012-2013, fomepizole was applied as an alternative antidote to ethanol. We present the laboratory data, clinical features, adverse reactions, and treatment outcomes in all patients treated with fomepizole. METHODS: Combined retrospective and prospective case series study in 25 patients, median age 50 (16-73) years, 18 males and 7 females. RESULTS: There were 24% fatalities, 36% survivors without health impairment, and 40% survivors with sequelae. All the patients who died were comatose on admission; the mortality was 50% among patients in a coma. The median intensive care unit length of stay was six (2-22) days. The median total dose of fomepizole was 2 (1-9) g. Complications were observed in 7/25 cases: aspiration pneumonia (4), sepsis (2), bleeding (2), malignant arrhythmia (1), delirium tremens (1), and rebound of acidosis (1). The patients who survived without impairment were less acidotic than those who died or survived with sequelae (P<0.01). No difference in serum methanol and formate was found between the three groups. CONCLUSION: There is no evidence whether fomepizole is a more efficient antidote than ethanol with regards to the hospital mortality. The possibility of delirium tremens in the patients with a history of chronic alcohol abuse has to be taken in consideration. The benefits of fomepizole were indirect: no need to monitor serum ethanol's level during the hemodialysis in severely poisoned patients and less working overload on ICU doctors treating several poisoned patients simultaneously.

Toxicological Information Center Department of Occupational Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

References provided by Crossref.org

Intermittent versus continuous renal replacement therapy in acute methanol poisoning: comparison of clinical effectiveness in mass poisoning outbreaks

Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning

"It can't happen to me": Alcohol drinkers on the 2012 outbreak of methanol poisonings and the subsequent prohibition in the Czech Republic

Severe Methanol Poisoning with Supralethal Serum Formate Concentration: A Case Report