Visual Outcomes in Acute Methyl Alcohol poisoning and its Biochemical Predictors: A Hospital-Based Study in Eastern India

Subject Areas : Journal of Chemical Health Risks

Suchismita Mishra ¹ , Pradeep Panigrahi ² , Priya Gupta ³ , Keya Chakrabarti ⁴

1 - Department of Ophthalmology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan (deemed to be University), 8-Kalinga Nagar, Bhubaneswar-751003
2 - Department of Ophthalmology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan (deemed to be University), 8-Kalinga Nagar, Bhubaneswar-751003
3 - Department of Ophthalmology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan (deemed to be University), 8-Kalinga Nagar, Bhubaneswar-751003
4 - Department of Ophthalmology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan (deemed to be University), 8-Kalinga Nagar, Bhubaneswar-751003

Received: 2022-02-14 Accepted : 2022-10-26 Published : 2023-06-01

Keywords: Methanol, Hemodialysis, Methyl alcohol, Metabolic acidosis, Anion gap,

Abstract :

Acute methyl alcohol toxicity can lead to severe ocular morbidity. In the present study, we aimed to observe the ocular outcomes in acute methyl alcohol poisoning and determine the biochemical predictors of the final visual outcome. This was a hospital- based descriptive study conducted on 19 consecutive patients of acute methanol poisoning presenting to the Ophthalmology department of a tertiary care multispecialty hospital in Eastern India. Thorough clinical history was obtained in each case. A comprehensive ocular examination was done. Details of systemic treatment provided were obtained in all cases. Nineteen patients were included in the study. All patients were males. The average age of patients was 35.84 ± 9.25 years. All patients complained of bilateral blurring of vision. One patient had severe vision loss with visual acuity of hand movements in both eyes. . Colour vision was absent in 7 eyes (18.41%), and impaired in 5 eyes (13.15%). Disc edema was seen in 5 eyes (13.15%). High anion gap metabolic acidosis was seen in 13 (78.9%) cases. Serum bicarbonate level was < 22 mmol L-1 in 13 (68.42%) patients. Eleven (57.89%) patients underwent hemodialysis. The presence of metabolic acidosis, high anion gap, and high base deficit were associated with poor visual acuity and defective color vision both at the initial presentation and final follow-up. Metabolic acidosis, high anion gap, and base deficit at the time of presentation are associated with defective color vision, abnormal pupillary reaction, and poor vision both during initial and final visits. Prompt management of these metabolic abnormalities can decrease ocular morbidity and improve the final visual outcomes.

References:

1. Kadam D.B., Salvi S., Chandanwale A., 2018. Methanol poisoning. Journal of the Association of Physicians of India. 66, 47-50.


2. Rathi M., Sakhuja V., Jha V., 2006. Visual blurring and metabolic acidosis after ingestion of bootlegged alcohol. Hemodial Int. 10, 8-14.


3. Cursiefen C., Bergua A., 2002. Acute bilateral blindness caused by accidental methanol intoxication during fire "eating". Br J Ophthalmol. 86, 1064-1065.


4. Sharpe J.A., Hostovsky M., Bilbao J.M., Rewcastle N.B., 1982. Methanol optic neuropathy: a histopathological study. Neurology. 32, 1093-1100.


5. Kruse J.A., 1992. Methanol Poisoning. Intensive Care Med. 18, 391-7.


6. Eren N., Gungor O., Sarisik F.N., Sokmen F., Tutuncu D., Cetin G.Y., 2020. Renal Tubular Acidosis in Patients with Systemic Lupus Erythematosus. Kidney Blood Press Res. 45, 883-889.


7. Lim S., 2007. Metabolic acidosis. Acta Med Indones. 39, 145-50.


8. Dethlefs R., Naraqi S., 1978. Ocular manifestations and complications of acute methyl alcohol intoxication. Med J Aust. 2, 483-5.


9. Onder F., Ilker S., Kansu T., Tatar T., Kural G., 1998. Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol. 22, 81–4.


10. Mahieu P., Hassoun A., Lauwerys R., 1989. Predictors of methanol intoxication with unfavourable outcome. Hum Toxicol. 8, 135-137.


11. Martin-Amat G., McMartin K.E., Hayreh S.S., Hayreh M.S., Tephly T.R., 1978. Methanol poisoning: ocular toxicity produced by formate. Toxicol Appl Pharmacol. 45, 201–8.


12. Kraut J.A., Kurtz I., 2008. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am SocNephrol. 3, 208–25.


13. Sharma R., Marasini S., Sharma A.K., Shrestha J.K., Nepal B.P., 2012. Methanol Poisoning: Ocular and Neurological Manifestations. Optom Vis Sci. 89, 178–182


14. Lin E.S., Buckley T., Li E., Lai K.N., Oh T.E., 1989. Case reports: a case of severe methanol intoxication. J Hong Kong Med Assoc. 41, 273–4.


15. Sullivan-Mee M., Solis K., 1998. Methanol-induced vision loss. J Am Optom Assoc. 69, 57–65.


16. Jacobson B.M., Russel H.K., 1945. AcuteMethyl alcohol poisoning. U.S. Nav M Bull. 44, 1099-1106.


17. Patel J.K., Narang S.K., 1970. Eye changes in methyl alcohol poisoning. Indian J Ophthalmol. 18, 125-7


18. Roe O., 1943. Clinical investigations of methyl alcohol poisoning. Acta Med Scand. 113, 558–608.


19. Shin Y.W., Uhm K.B., 2011. A case of optic nerve atrophy with severe disc cupping after methanol poisoning. Korean J Ophthalmol. 25, 146-50.


20. Ravichandran R., Dudani R.A., Almeida A.F., Chawla K.P., Acharya V.N., 1984. Methyl alcohol poisoning. (Experience of an outbreak in Bombay). J Postgrad Med. 30, 69–74.


21. Barceloux D.G., Bond G.R., Krenzelok E.P., Cooper H., Vale J.A., 2002. American Academy of Clinical Toxicology Ad Hoc Committee on the Treatment Guidelines for Methanol Poisoning. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 40, 415-46.


22. Shukla M., Shikoh I., Saleem A., 2006. Intravenous methylprednisolone could salvage vision in methyl alcohol poisoning. Indian J Ophthalmol. 54, 68–9.


23. Desai T., Sudhalkar A., Vyas U., Khamar B., 2013. Methanol poisoning: predictors of visual outcomes. JAMA Ophthalmol. 131, 358-364.