Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning. (7th February 2017)

• Record Type: Journal Article
• Authors: Zakharov, Sergey; Pelclova, Daniela; Navratil, Tomas; Belacek, Jaromir; Latta, Jiri; Pisar, Michal; Rulisek, Jan; Leps, Jiri; Zidek, Pavel; Kucera, Cyril; Bocek, Robert; Mazur, Miroslav; Belik, Zdenek; Chalupa, Josef; Talafa, Viktor; Kodras, Kamil; Nalos, Daniel; Sedlak, Ctirad; Senkyrik, Michal; Smid, Jan; Salek, Tomas; Roberts, Darren M.; Hovda, Knut Erik
• Is Part Of: Clinical toxicology. Volume 55:Number 2(2017)
• Page Start: 123
• Page End: 132
• Publication Date: 2017-02-07
• Subjects: Acidemia -- continuous veno-venous hemodialysis -- extended daily hemodialysis -- intermittent hemodialysis -- metabolic acidosis -- methanol poisoning; Toxicology -- Periodicals; Toxicological emergencies -- Periodicals; 615.9
• DOI: 10.1080/15563650.2016.1250901
• Languages: English
• ISSNs: 1556-3650

Abstract

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.