Methanol Poisoning with Fatality- Case Series in Dhaka Medical College Hospital in Bangladesh Mohammad Robed Amin * , ABM Sayeduzzaman Shohagh, Ariful Basher, Muhibur Rahman, Mohammad Abul Faiz and HAM Nazmul Ahasan Department of Medicine, Medicine Unit X, Dhaka Medical College Hospital, Bangladesh * Corresponding author: Mohammad Robed Amin, Department of Medicine, Medicine Unit X, Dhaka Medical College Hospital, Bangladesh, Tel: 01711725787; E-mail: robedamin@yahoo.com Received date: December 24, 2016; Accepted date: January 18, 2017; Published date: January 23, 2017 Copyright: © 2017 Amin MR, et al. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Adulterated methanol is highly toxic and leads to severe metabolic acidosis and blindness and mortality is very high if not treated with specific antidote. The time of ingestion and severity of illness is very short and comprehensive quick assessment and care is crucial for survival of patient. The selective antidote Fomepizole is not available in Bangladesh and pure intravenous ethanol is also out of reach in health care facility. The oral ethanol has its legislative regulation. Occasional clusters of severe methanol poisoning leading to fatality has been observed in recent years in Bangladesh. Here is a case series of 8 cases of adulterated methanol poisoning in a tertiary care hospital with lethality. Results and discussion: From November 2012 to January, 2013, in sphere of 3 months medicine units of Dhaka Medical College Hospital (DMCH) experienced 8 cases of methanol poisoning with fatality. Six patient presented in unconscious states within 3 to 7 h of consuming methanol while two patient presented within 48 h. All of them had gastrointestinal toxicity with variable episodes of vomiting. Three patients presented with visual impairment while only two out of eight had normal ophthalmoscopy. Respiratory distress was uniformly found in all patients before unstable profound shock. Blood ethanol level was not performed in any patient due to lack of available facility. Seven patients received only supportive measures ranging from steroids to sodium bi carbonate while one patient presented in severe toxicity and died quickly before any supportive measures. Antidote was not prescribed in any patient in the form of fomepizole or intravenous or oral ethanol. Conclusion: The judicious use of antidote even in the form of oral ethanol and folinic acid can save the precious life. A national guideline should be uniformly practiced by the physicians to combat the catastrophic methanol poisoning in Bangladesh. Keywords: Methanol; Poisoning; Fatal Introduction Methanol is methyl alcohol also known as wood alcohol or wood neptha synthesized from coke and water. Industrial methyllated spirit consists of 95% ethyl alcohol and 5% methyl alcohol. Mineralised methylated spirit contains 90% ethyl alcohol and 10% methyl alcohol [1]. It is used in many home chemicals, duplicating fuids, varnishes, stains, paint thinners and dyes. Methylated spirit is very cheap and frequently available; hence it is easily adulterated and used as country liquor among some Bangladeshi poor peoples who cannot aford ethyl alcohol for their drink. It becomes highly toxic when it is mixed with ethyl alcohol as it is adulerated. When taken with ethyl alcohol, it is metabolized only afer complete metabolisation of ethyl alcohol. In course of oxidation, formaldehyde and fnally formic acid are formed which are highly toxic [1,2]. Even as small amount as 10 ml can cause permanent blindness [3]. Formic acid is metabolized more slowly and, therefore, accumulates as the generation of formic acid exceeds the capacity to eliminate it [4,5]. A direct correlation between formic acid accumulation and the toxicity of methanol leading to mortality and morbidity is established [5]. Beside the gastrointestinal symptoms of anorexia, nausea, vomiting, diarrhea there may be CNS, eye, respiratory and renal toxicity. Dyspnoea and respiratory failure is the cause of death in most patient [2,6]. Metabolic acidosis is sometimes refractory and one of important cause of mortality. Lactate is produced as formic acid interferes with intracellular respiration and promotes anaerobic metabolism. As lactate concentrations rise and tissue hypoxia increases, the pH falls further and leads to the generation of more undissociated formic acid [7,8]. Both formate and lactic acid contribute to the anion gap increase seen in methanol poisoning. Te early acidosis observed in methanol poisoning may be due to the accumulation of formate, with lactate accumulation occurring in the later stages of poisoning from tissue hypoxia and inhibition of cellular respiration by formic acid [9]. Ethyl alcohol is preferentially metabolized by alcohol dehydrogenase resulting in reduced methanol toxicity. Ethanol competitively inhibits the metabolism of methanol to its toxic metabolite, formate, by occupying the receptor sites of alcohol dehydrogenase. Fomepizole has been shown to be a potent inhibitor of alcohol dehydrogenase in man [10]. From November 2012 to January, 2013, in sphere of 3 months medicine units of Dhaka Medical College Hospital (DMCH) experienced 8 cases of methanol poisoning with fatality. Here is the case series of 8 cases of methanol poisoning with their management and fatal outcome that has been observed in DMCH. Toxicology: Open Access Amin et al., Toxicol Open Access 2017, 3:1 Case Report OMICS International Volume 3 • Issue 1 • 1000121 DOI: 10.4172/2476-2067.1000121 Toxicol Open Access, an open access journal ISSN:2476-2067