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Anderson KE, Balasanova AA. A case of a patient requiring medically supervised withdrawal after ingestion of witch hazel toner as a surrogate alcohol. Clin Case Rep 2024; 12:e9007. [PMID: 38799527 PMCID: PMC11126643 DOI: 10.1002/ccr3.9007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical Message Standardized alcohol withdrawal treatments, such as the phenobarbital taper protocol, are effective in the management of alcohol withdrawal syndromes associated with surrogate alcohols including witch hazel toner. Abstract Ingestion of alcohol not intended for consumption, also known as surrogate alcohols, is well-documented in patients with alcohol use disorder. Ingestion of surrogate alcohols may lead to higher morbidity and mortality than standard alcohol consumption alone. However, management of complications such as withdrawal syndromes in individuals consuming surrogate alcohols has received little attention in the literature. We present the case of a patient with alcohol use disorder who required medically supervised withdrawal following ingestion of witch hazel toner as a surrogate alcohol. Review of patient's history revealed routine ingestion of witch hazel toner as a substitute to traditional alcohols. Witch hazel toner is a non-FDA regulated product designed for topical use; it is commonly sold in a steam distilled formulation containing 13%-15% ethanol and small amounts of essential oil components, such as carvacrol and eugenol. During hospitalization the patient received treatment of alcohol withdrawal with a phenobarbital taper protocol and was discharged in stable condition. He also received resources for alcohol use disorder to follow-up in the outpatient setting. To our knowledge this is the first reported case of a patient requiring medically supervised withdrawal following ingestion of witch hazel toner and sheds light on the potential complications and management of patients who present following ingestion.
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Affiliation(s)
- Kayley E. Anderson
- College of Medicine, University of Nebraska Medical CenterOmahaNebraskaUSA
| | - Alëna A. Balasanova
- Department of Psychiatry, College of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Sobhi N, Abdollahi M, Arman A, Mahmoodpoor A, Jafarizadeh A. Methanol Induced Optic Neuropathy: Molecular Mysteries, Public Health Perspective, Clinical Insights and Treatment Strategies. Semin Ophthalmol 2024:1-12. [PMID: 38804878 DOI: 10.1080/08820538.2024.2358310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
Methanol-induced optic neuropathy (MION) represents a critical public health issue, particularly prevalent in lower socioeconomic populations and regions with restricted alcohol access. MION, characterized by irreversible visual impairment, arises from the toxic metabolization of methanol into formaldehyde and formic acid, leading to mitochondrial oxidative phosphorylation inhibition, oxidative stress, and subsequent neurotoxicity. The pathogenesis involves axonal and glial cell degeneration within the optic nerve and potential retinal damage. Despite advancements in therapeutic interventions, a significant proportion of affected individuals endure persistent visual sequelae. The study comprehensively investigates the pathophysiology of MION, encompassing the absorption and metabolism of methanol, subsequent systemic effects, and ocular impacts. Histopathological changes, including alterations in retinal layers and proteins, Müller cell dysfunction, and visual symptoms, are meticulously examined to provide insights into the disease mechanism. Furthermore, preventive measures and public health perspectives are discussed to highlight the importance of awareness and intervention strategies. Therapeutic approaches, such as decontamination procedures, ethanol and fomepizole administration, hemodialysis, intravenous fluids, electrolyte balance management, nutritional therapy, corticosteroid therapy, and erythropoietin (EPO) treatment, are evaluated for their efficacy in managing MION. This comprehensive review underscores the need for increased awareness, improved diagnostic strategies, and more effective treatments to mitigate the impact of MION on global health.
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Affiliation(s)
- Navid Sobhi
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mirsaeed Abdollahi
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Arman
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Intensive care, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Nasiri E, Orimi JR, Hashemimehr M, Aghabeiglooei Z, Rezghi M, Amrollahi-Sharifabadi M. Avicenna's clinical toxicology approach and beneficial materia medica against oral poisoning. Arch Toxicol 2023; 97:981-989. [PMID: 36862191 DOI: 10.1007/s00204-023-03464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
Considering the rich background of Persian Medicine in the use of materia medica for the treatment of diseases, the huge burden of oral poisonings in the world, and the urgent need to find scientific solutions, the purpose of this study was to determine Avicenna's approach toward clinical toxicology and his proposed treatments for oral poisonings. In Al-Qanun Fi Al-Tibb, Avicenna addressed the materia medica for the treatments of oral poisonings after explaining the ingestion of different toxins and also elucidating the clinical toxicology approach toward poisoned patients. These materia medica were from different classes including emetics, purgatives, enemas, diaphoretics, antidiarrheals, inhaled drugs, sternutators, anticoagulants, antiepileptics, antitussives, diuretics, cooling drugs, stimulants, cardiotonic drugs, and heating oils. By applying different therapies, Avicenna endeavored to attain main goals in clinical toxicology that are comparable with modern medicine. They included removing the toxins from the body, decreasing the severity of the deleterious effects of toxins on the body, and counteracting the effects of toxins inside the body. Aside from introducing different therapeutic agents that played an important role in the treatment of oral poisonings, he emphasized the ameliorating effects of nutritive foods and beverages. Further research using other Persian medical resources is recommended to elucidate the applicable approaches and treatments for different poisonings.
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Affiliation(s)
- Ebrahim Nasiri
- Department of Anesthesiology and Operating Room, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamal Rezaei Orimi
- Department of History of Medical Sciences, School of Allied of Medical Sciences, Mazanadaran University of Medical Sciences, Sari, Iran
- Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Hashemimehr
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Aghabeiglooei
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Rezghi
- Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Amrollahi-Sharifabadi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Lorestan University, 5Th Kilometer of Khorramabad-Boroujerd Highway, Khoramabad, Lorestan, Iran.
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Decker ME, Briski ND, Salem A, Noor E, Khashan A. Methanol Intoxication-Associated Brain Hemorrhages: Can Early Detection Be Life-Saving? A Case Report. Am J Case Rep 2023; 24:e938749. [PMID: 36710478 PMCID: PMC9896127 DOI: 10.12659/ajcr.938749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Methanol can cause many acute complications when ingested, either intentionally or accidentally. One rare complication is cerebral hemorrhage, which can present with focal neurologic deficits, decreased consciousness, and fixed, dilated pupils. With vigilant monitoring of patients in the acute period of toxicity, rapid identification, and initiation of treatment, outcomes can potentially be improved in these patients. CASE REPORT We present a case of a 42-year-old man who presented after ingestion of windshield wiper fluid. Initial symptoms started with fatigue and altered mental status, but he quickly developed abdominal pain and became obtunded. CT initially showed no acute hemorrhage or other pathology, but on day 2, despite receiving fomepizole, bicarbonate, and dialysis, the patient became hypotensive and showed loss of cranial nerve reflexes, and repeated CT head scans showed acute intracranial hemorrhage with mass effect. CONCLUSIONS Although the exact mechanism of intracranial hemorrhage and necrosis following methanol intoxication remains uncertain, we know beyond doubt that it can progress rapidly and lead to severe and irreversible complications, so identifying and treating it immediately is essential. In this case, methanol ingestion was known on presentation, antidote and renal replacement therapy were initiated within hours of ingestion, yet our patient still suffered fatal brain hemorrhage. Important warning signs of acute hemorrhage include loss of cranial nerve reflexes and decrease in consciousness, so these findings warrant further evaluation and prompt neuroimaging, especially in high-risk patients like the one in this report.
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Affiliation(s)
| | | | - Amira Salem
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Emad Noor
- Department of Neurology, JFK Medical Center, Edison, NJ, USA
| | - Abdallah Khashan
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ, USA,Corresponding Author: Abdallah Khashan, e-mail:
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Hoyte C, Schimmel J, Hadianfar A, Banerji S, Nakhaee S, Mehrpour O. Toxic alcohol poisoning characteristics and treatments from 2000 to 2017 at a United States regional poison center. Daru 2021; 29:367-376. [PMID: 34709587 DOI: 10.1007/s40199-021-00418-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Toxic alcohol exposures are an ongoing concern in the United States. In the US, few studies characterize the local epidemiology of toxic alcohols over time. OBJECTIVES The objective was to examine the incidence of toxic alcohol ingestions and changes in management over time. METHODS This retrospective cohort study evaluates toxic alcohol ingestion phone calls to a regional poison center in the United States covering four states. Data were queried for this poison center from the National Poison Data System (NPDS) using generic codes for each toxic alcohol. Inclusion criteria were ingestion of toxic alcohol, age ≥ 13 years, from January 1, 2000 to Dec 31, 2017. Exclusion criteria were unrelated effects coded in the medical outcome, duplicate data, or incomplete demographic data. RESULTS Of 926 subjects (adults and teenagers), 71.5% were male, and the mean age was 34.5 years. Toxic alcohol ingestion was more common in individuals younger than 40 years, with a significant relationship between age and intentional abuse or misuse (p = 0.001). There was also a significant relationship between age and reason for ingestion, with younger patients more likely to be suicidal (p < 0.001). Ethyleneglycol was the most common toxic alcohol. There was no change in the incidence of toxic alcohol ingestions over the study period. The mortality rate was 1.7%, and 31.2%of patients were hospitalized in a critical care unit. Major effects and death were more common in younger patients (p < 0.001). There was a significant difference in medical outcomes based on the type of toxic alcohol(p = 0.03). Fomepizole was the most common treatment. A Poisson regression model found no change in fomepizole use during the study period (p = 0.1). Ethanol administration over the study period increased (p = 0.02), while hemodialysis decreased (p = 0.02). CONCLUSION Data obtained from a single regional United States poison center showed low mortality related to toxic alcohol ingestions. The most prevalent toxic alcohol was Ethylene glycol. In all cases, toxic alcohol ingestion was higher in the 20-29-year-old age group. Reasons for ingestion, in most cases, were suicidal. Fomepizole was the most common treatment, ethanol administration as an antidote is rising, and hemodialysis utilization is decreasing. Data may not be nationally representative.
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Affiliation(s)
| | - Jonathan Schimmel
- Department of Emergency Medicine, Division of Medical Toxicology, Mount Sinai Hospital Icahn School of Medicine, New York, NY, USA
| | - Ali Hadianfar
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shireen Banerji
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Omid Mehrpour
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA. .,Scientific Unlimited horizon, Tucson, AZ, USA.
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Birková A, Hubková B, Čižmárová B, Bolerázska B. Current View on the Mechanisms of Alcohol-Mediated Toxicity. Int J Mol Sci 2021; 22:9686. [PMID: 34575850 PMCID: PMC8472195 DOI: 10.3390/ijms22189686] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 02/07/2023] Open
Abstract
Alcohol is a psychoactive substance that is widely used and, unfortunately, often abused. In addition to acute effects such as intoxication, it may cause many chronic pathological conditions. Some of the effects are very well described and explained, but there are still gaps in the explanation of empirically co-founded dysfunction in many alcohol-related conditions. This work focuses on reviewing actual knowledge about the toxic effects of ethanol and its degradation products.
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Affiliation(s)
- Anna Birková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04011 Kosice, Slovakia
| | - Beáta Hubková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04011 Kosice, Slovakia
| | - Beáta Čižmárová
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04011 Kosice, Slovakia
| | - Beáta Bolerázska
- 1st Department of Stomatology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 04011 Kosice, Slovakia
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Ivaturi K, Ferrey AJ, Nguyen L, Tonthat S, Kohli S, Torres EA, Kalantarzadeh K, Hanna R. Metabolic acidosis due to ingestion of lanthanum sulfates and chlorides in cetyl alcohol solution pool cleaner. Clin Case Rep 2021; 9:e04121. [PMID: 34026161 PMCID: PMC8123548 DOI: 10.1002/ccr3.4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 11/09/2022] Open
Abstract
Cetyl Alcohol is a rare cause of acidosis if ingested in large quantities. Hyponatremia with overlapping anion gap and osmolal gap-positive metabolic acidosis may appear to have iso-osmolar serum. This is a case of an unusual toxic exposure.
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Affiliation(s)
- Kaushik Ivaturi
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
| | - Antoney J. Ferrey
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
| | - Lawrence Nguyen
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
| | - Sam Tonthat
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
| | - Sanjivan Kohli
- Department of Medicine‐Division of Critical Care and Pulmonary MedicineUniversity of California IrvineOrangeCAUSA
| | | | - Kamyar Kalantarzadeh
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
| | - Ramy Hanna
- Department of Medicine‐Division of NephrologyUniversity of California IrvineOrangeCAUSA
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Smit A, Lalloo V, Engelbrecht A. Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis. Afr J Emerg Med 2021; 11:37-38. [PMID: 33425670 PMCID: PMC7779712 DOI: 10.1016/j.afjem.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Due to the nationwide lockdown to mitigate the spread of COVID-19 and subsequent alcohol ban in South Africa, several cases of toxic alcohol ingestion presented to our emergency unit. Many of these patients admitted to making home brews of alcohol while others simply use industrial toxic alcohols. The diagnosis of these poisonings is challenging as direct assays are not available in our setting. Case report We present a case of presumed ethylene glycol poisoning that presented with persistent seizures and a high anion gap metabolic acidosis (HAGMA). Discussion A high index of suspicion for toxic alcohol poisoning should be maintained in patients presenting with an altered mental status, seizures and a HAGMA. Indirect markers such as clinical features and laboratory results can lead to the diagnosis when direct assays are unavailable.
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Atluri P, Vasireddy D, Malayala SV. Toxic Alcohol Ingestion: A Case Report and Review of Management Pathways. Cureus 2021; 13:e13092. [PMID: 33728115 PMCID: PMC7934107 DOI: 10.7759/cureus.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Toxic alcohol ingestion can be fatal or produce irreversible tissue damage and hence timely recognition and treatment are very important. The physician has to often rely on clinical features and different lab values in order to derive the possible causative agent consumed. Gas chromatography is the definitive diagnostic test to detect the toxic alcohol but is unfortunately not available to run in house in most hospital laboratories in the acute clinical setting. We present a 41-year-old gentleman who was brought to the ED for further evaluation of vomiting and upper abdominal pain. Our clinical impression was that the patient had possible mixed toxic alcohol ingestion. General principles and treatment of alcohol intoxication include gastric lavage or use of activated charcoal. Administration of ethanol or fomepizole to delay or prevent generation of toxic metabolites needs to be initiated while sufficient alcohol remains and metabolized and measurement of blood alcohol concentrations and/or serum osmolality can be helpful. Dialysis is helpful in removing unmetabolized alcohol and possibly toxic metabolites and delivering base to patients to ameliorate metabolic acidosis.
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Sefidbakht S, Lotfi M, Jalli R, Moghadami M, Sabetian G, Iranpour P. Methanol toxicity outbreak: when fear of COVID-19 goes viral. Emerg Med J 2020; 37:416. [PMID: 32414710 PMCID: PMC7413583 DOI: 10.1136/emermed-2020-209886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sepideh Sefidbakht
- Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran (the Islamic Republic of)
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran (the Islamic Republic of)
| | - Reza Jalli
- Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran (the Islamic Republic of)
| | - Mohsen Moghadami
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Iranpour
- Medical Imaging Research Center, Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran (the Islamic Republic of)
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