Abstract
We performed a retrospective study in 86 patients from the Czech methanol outbreak in 2012 to determine the role of anion and osmolal gaps in diagnosis and prognosis of methanol poisoning. Methanol and ethanol were measured by a gas chromatographic method with flame ionization detection. Formate was measured enzymatically. Osmolality was measured by freezing point depression method. From 86 patients, 15 died, 47 survived without, and 24 survived with visual/CNS sequelae. There was a statistically significant correlation between the osmolal gap and serum methanol concentrations (R 2 = 0.704; p < 0.001); however, the sensitivity was low for the detection of serum methanol under 20 mmol dm−3. The survivors without sequelae had lower osmolal gap than those who survived with visual/CNS damage (p = 0.002). The correlation between the anion gap and serum formate on admission was significant (R 2 = 0.28; p < 0.05). The anion gap well correlated with the variables characterizing the severity of metabolic acidosis: blood pH, base deficit, and lactate concentrations (all p < 0.001). The group of survivors without sequelae differed from both other groups in serum anion gap (all p < 0.001). The group of survivors with sequelae did not differ from those who died in anion gap, base deficit, serum bicarbonate, and formate concentrations (all p > 0.05). The measurement of the serum anion and osmolal gaps is a useful laboratory method of early diagnosis of acute methanol poisoning. Anion gap is a reliable indicator of the severity of poisoning in the late-presenting patients. Increased osmolal gap helps in diagnosing methanol poisoning at an early stage before the results of gas chromatography measurement are available.
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Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D (2005) J Intern Med 258:181
Paasma R, Hovda KE, Tikkerberi A, Jacobsen D (2007) Clin Toxicol 45:152
Zakharov S, Pelclova D, Urban P, Navratil T, Diblik P, Kuthan P, Hubacek JA, Miovsky M, Klempir J, Vaneckova M, Seidl Z, Pilin A, Fenclova Z, Petrik V, Kotikova K, Nurieva O, Ridzon P, Hovda KE (2014) Clin Toxicol. doi:10.3109/15563650.2014.974106
Navratil T, Zakharov S, Pelclova D, Mrazova K (2013) Short information on methanol outbreak in the Czech republic in the year 2012. In: Navratil T, Fojta M, Peckova K (eds) Modern electrochemical methods XXXIII. Jetrichovice, Best Servis, p 123
Navratil T, Svancara I, Mrazova K, Novakova K, Sestakova I, Heyrovsky M, Pelclova D (2011) Mercury and mercury electrodes: the ultimate battle for the naked existence (a consideration). In: Kalcher K, Metelka R, Svancara I, Vytras K (eds) Sensing in electroanalysis, vol 6. University Press Centre, Pardubice, p 23
Navratil T, Zakharov S, Pelclova D, Mrazova K (2014) Methanol outbreak in the Czech republic in the year 2012—almost two years later. In: Navratil T, Fojta M, Peckova K (eds) Modern electrochemical methods XXXIV. Jetrichovice, Best Servis, p 104
Bucaretchi F, De Capitani EM, de Madureira PR, Cesconetto DM, Lanaro R, Vieira RJ (2009) Sao Paulo Med J 127:108
Zakharov S, Navratil T, Pelclova D (2013) Basic Clin Pharmacol Toxicol 112:425
Zakharov S, Navratil T, Pelclova D (2013) Psychiatry Res 210:302
Zakharov S, Nurieva O, Navratil T, Diblik P, Kuthan P, Pelclova D (2014) J Appl Biomed 12:309
Megarbane B, Borron SW, Baud FJ (2005) Intensive Care Med 31:189
Vaneckova M, Zakharov S, Klempir J, Ruzicka E, Bezdicek O, Liskova I, Diblik P, Miovsky M, Hubacek JA, Urban P, Ridzon P, Pelclova D, Burgetova A, Masek M, Seidl Z (2014) Cesk Slov Neurol N 77:235
Bezdicek O, Klempir J, Liskova I, Michalec J, Vaneckova M, Seidl Z, Janikova B, Milovsky M, Hubacek JA, Diblik P, Kuthan P, Pilin A, Kurcova I, Fenclova Z, Petrik V, Navratil T, Pelclova D, Ruzicka E, Zakharov S (2014) Cesk Slov Neurol N 77/110:320
Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA (2002) J Toxicol-Clin Toxicol 40:415
Zakharov S, Navratil T, Pelclova D (2014) Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. doi:10.5507/bp.2014.056
Zakharov S, Pelclova D, Navratil T, Belacek J, Kurcova I, Komzak O, Salek T, Latta J, Turek R, Bocek R, Kucera C, Hubacek JA, Fenclova Z, Petrik V, Cermak M, Hovda KE (2014) Kidney Int 86:199
Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D (2004) Intensive Care Med 30:1842
Hubacek JA, Pelclova D, Seidl Z, Vaneckova M, Klempir J, Ruzicka E, Ridzon P, Urban P, Fenclova Z, Petrik V, Diblik P, Kuthan P, Miovsky M, Janikova B, Adamkova V, Zakharov S (2014) Basic Clin Pharmacol Toxicol. doi:10.1111/bcpt.12310
Zakharov S, Kurcova I, Navratil T, Salek T, Komarc M, Pelclova D (2014) Basic Clin Pharmacol Toxicol. doi:10.1111/bcpt.12338
Hovda KE, Urdal P, Jacobsen D (2005) J Anal Toxicol 29:586
Aabakken L, Johansen KS, Rydningen EB, Bredesen JE, Ovrebo S, Jacobsen D (1994) Hum Exp Toxicol 13:131
Liu JJ, Daya MR, Carrasquillo O, Kales SN (1998) J Toxicol. Clin Toxicol 36:175
Lushine KA, Harris CR, Holger JS (2003) J Emerg Med 24:433
Brent J, McMartin K, Phillips S, Aaron C, Kulig K (2001) N Engl J Med 344:424
Jacobsen D, Hovda KE (2007) Methanol. In: Shannon MW, Borron SW, Burns MJ (eds) Haddad and Winchester’s clinical management of poisoning and drug overdose. WB Saunders, Philadelphia, p 605
Zakharov S, Navratil T, Pelclova D (2012) Basic Clin Pharmacol Toxicol 110:427
Blomme B, Lheureux P, Gerlo E, Maes V (2001) J Anal Toxicol 25:77
Sanaei-Zadeh H, Esfeh SK, Zamani N, Jamshidi F, Shadnia S (2011) J Med Toxicol 7:189
Acknowledgments
Supported with the Projects of the Charles University in Prague P25/1LF/2 and P28/1LF/6, with the Project of the Ministry of Health of the Czech Republic 12/14/NAP, the Czech Science Foundation (project GA ČR No. P208/12/1645) and with EU Project “Material- technical Research Base for the Diagnostics and Treatment of Environmentally-caused and Oncological Disorders and their Risks, in the General University Hospital in Prague” (reg. No. CZ.2.16/3.1.00/24.12).
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Zakharov, S., Navrátil, T. & Pelclova, D. Analysis of serum anion gap and osmolal gap in diagnosis and prognosis of acute methanol poisoning: clinical study in 86 patients. Monatsh Chem 146, 787–794 (2015). https://doi.org/10.1007/s00706-014-1374-7
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DOI: https://doi.org/10.1007/s00706-014-1374-7