1013 Czech mass methanol outbreak 2012: Epidemiology, challenges and clinical features SERGEY ZAKHAROV, 1 DANIELA PELCLOVA, 1 PAVEL URBAN, 1 TOMAS NAVRATIL, 1,2 PAVEL DIBLIK, 3 PAVEL KUTHAN, 3 JAROSLAV A. HUBACEK, 4 MICHAL MIOVSKY, 5 JIRI KLEMPIR, 6 MANUELA VANECKOVA, 7 ZDENEK SEIDL, 7 ALEXANDER PILIN, 8 ZDENKA FENCLOVA, 1 VIT PETRIK, 1 KATERINA KOTIKOVA, 1 OLGA NURIEVA, 1 PETR RIDZON, 1 JAN RULISEK, 10 MARTIN KOMARC, 11 and KNUT ERIK HOVDA 9 1 Department of Occupational Medicine,Toxicological Information Center, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic 2 Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of AS CR, v.v.i, Prague, Czech Republic 3 Department of Ophthalmology, General University Hospital, Prague, Czech Republic 4 Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic 5 Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic 6 Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic 7 Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic 8 Department of Toxicology and Forensic Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic 9 Department of Acute Medicine, Oslo University Hospital, Norwegian CBRNe Centre of Medicine, Oslo, Norway 10 Department of Anesthesiology, Resuscitation and Intensive Medicine, General University Hospital, Prague, Czech Republic 11 Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University in Prague, Czech Republic Objectives. Methanol poisonings occur frequently globally, but reports of larger outbreaks where complete clinical and laboratory data are reported remain scarce. The objective of the present study was to report the data from the mass methanol poisoning in the Czech Republic in 2012 addressing the general epidemiology, treatment, and outcomes, and to present a protocol for the use of fomepizole ensuring that the antidote was provided to the most severely poisoned patients in the critical phase. Methods. A combined prospective and retrospective case series study of 121 patients with confrmed methanol poisoning. Results. From a total of 121 intoxicated subjects, 20 died outside the hospital and 101 were hospitalized. Among them, 60 survived without, and 20 with visual/CNS sequelae, whereas 21 patients died. The total and hospital mortality rates were 34% and 21%, respectively. Multivariate regression analysis found pH  7.0 (OR 0.04 (0.01–0.16), p  0.001), negative serum ethanol (OR 0.08 (0.02–0.37), p  0.001), and coma on admission (OR 29.4 (10.2–84.6), p  0.001) to be the only independent parameters predicting death. Continuous hemodialysis was used more often than intermittent hemodialysis, but there was no signifcant difference in mortality rate between the two [29% ( n = 45) vs 17% ( n = 30), p = 0.23]. Due to limited stockpiles of fomepizole, ethanol was administered more often; no difference in mortality rate was found between the two [16% ( n = 70) vs. 24% ( n = 21), p = 0.39]. The effect of folate administration both on the mortality rate and on the probability of visual sequelae was not signifcant (both p  0.05). Conclusions. Severity of metabolic acidosis, state of consciousness, and serum ethanol on admission were the only signifcant parameters associated with mortality. The type of dialysis or antidote did not appear to affect mortality. Recommendations that were issued for hospital triage of fomepizole administration allowed conservation of valuable antidote in this massive poisoning outbreak for those patients most in need. Keywords Methanol poisoning; Epidemiology; Symptoms; Prognosis; Treatment; Outcomes Clinical Toxicology (2014), 52, 1013–1024 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2014.974106 CRITICAL CARE Received 11 May 2014; accepted 2 October 2014. Address correspondence to Sergey Zakharov, Department of Occupational Medicine,Toxicological Information Center, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic. E-mail: Sergey.Zakharov@vfn.cz Introduction Mass methanol poisonings have represented a challenge for healthcare providers throughout the world since the 19th century. 1–4 Morbidity and mortality in methanol Clinical Toxicology Downloaded from informahealthcare.com by UBO Bib for Hum og Samfunnsviten on 01/14/15 For personal use only.