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Clin Toxicol (Phila). 2017 Feb;55(2):123-132. doi: 10.1080/15563650.2016.1250901. Epub 2016 Nov 7.

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning.

Author information

1
a Department of Occupational Medicine, First Faculty of Medicine , Toxicological Information Centre, Charles University and General University Hospital , Prague , Czech Republic.
2
b First Faculty of Medicine , Institute of Medical Biochemistry and Laboratory Diagnostics, Charles University and General University Hospital , Prague , Czech Republic.
3
c J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i , Prague , Czech Republic.
4
d First Faculty of Medicine , Institute of Biophysics and Informatics, Charles University and General University Hospital , Prague , Czech Republic.
5
e Department of Internal Medicine , Tomas Bata Regional Hospital, Zlin , Czech Republic.
6
f Department of Anesthesiology , Resuscitation, and Intensive Medicine, General University Hospital , Prague , Czech Republic.
7
g Department of Anesthesiology and Resuscitation , Znojmo City Hospital , Znojmo, Czech Republic.
8
h Department of Anesthesiology and Resuscitation , Benešov City Hospital, Benešov , Czech Republic.
9
i Department of Anesthesiology and Resuscitation , Ostrava City Hospital, Ostrava , Czech Republic.
10
j Department of Anesthesiology and Intensive Medicine , Havířov Hospital, Havířov , Czech Republic.
11
k Department of Anesthesiology and Intensive Medicine , Karvina-Raj Hospital , Orlova , Czech Republic.
12
l Department of Anesthesiology and Resuscitation , Frydek-Mistek City Hospital, Frydek-Mistek , Czech Republic.
13
m Department of Internal Medicine , Frydek-Mistek City Hospital, Frydek-Mistek , Czech Republic.
14
n Department of Anesthesiology and Resuscitation , Kladno City Hospital, Kladno , Czech Republic.
15
o Department of Anesthesiology and Resuscitation , Masaryk Hospital, Ústínad Labem , Czech Republic.
16
p Department of Anesthesiology and Intensive Care Medicine , University Hospital Olomouc , Olomouc, Czech Republic.
17
q Department of Internal Medicine , Faculty Hospital Brno , Brno, Czech Republic.
18
r Department of Internal Medicine , Ostrava City Hospital, Ostrava , Czech Republic.
19
s Department of Clinical Biochemistry , Tomas Bata Regional Hospital, Zlin , Czech Republic.
20
t Medical School, Australian National University , Canberra , Australia.
21
u Department of Acute Medicine , The Norwegian CBRNe Centre of Medicine, Oslo University Hospital , Oslo , Norway.

Abstract

CONTEXT:

Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined.

OBJECTIVE:

We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning.

METHODS:

The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO3-, 0.01 unit arterial blood pH, and the total time for correction of HCO3- were determined in IHD- and CRRT-treated patients.

RESULTS:

Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p = 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO3- correction correlated with arterial blood pH (r= -0.511; p = 0.003) and creatinine (r = 0.415; p = 0.020). There was association between the time to HCO3- correction and dialysate/effluent and blood flow rates (r= -0.738; p < 0.001 and r= -0.602; p < 0.001, correspondingly). The mean time for HCO3- to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p = 0.024). The mean increase in HCO3- was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001).

CONCLUSIONS:

Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.

KEYWORDS:

Acidemia; continuous veno-venous hemodialysis; extended daily hemodialysis; intermittent hemodialysis; metabolic acidosis; methanol poisoning

PMID:
27817225
DOI:
10.1080/15563650.2016.1250901
[Indexed for MEDLINE]

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