Intoxication by Hand-Sanitizers and other Toxic Alcohols in a Low-Resource Setting: Two Case Reports

Toxic alcohol poisoning can be lethal if not identified early and treated appropriately. Toxic alcohol assays are often unavailable in low-resource setting, so clinicians have to infer a diagnosis based on suspicion, repeated evaluation and biochemical course. We report a case of toxic alcohol poisoning concealed by auto-intoxication with in-hospital hand sanitizer. The eventual appearance of a concurrent high anion gap prompted dialysis. In another case, a comatose patient presented with a high osmolal gap and a high anion gap. Incorrect a priori opinions caused us to defer dialysis and the patient died shortly afterwards. Clinicians should be aware that toxic alcohol poisoning can produce a confusing diagnostic picture with an insidious course, and that doctor delay can prove fatal.

Severe methanol poisoning treated with a novel hemodialysis system: a case report, analysis, and review

In May and June 2020, an outbreak of methanol poisoning arose in the southwest United States linked to ingestion of contaminated hand sanitizer imported during the coronavirus disease 2019 pandemic, ultimately resulting in over a dozen hospitalizations and at least four deaths in New Mexico and Arizona. In this report, we describe one of these cases in which profound methanol intoxication was successfully treated with the Tablo® Hemodialysis System, the first reported case of toxic alcohol poisoning treated with this novel device. We carry out a formal regression analysis of the serial methanol levels obtained in this case to conservatively estimate that intermittent hemodialysis with Tablo achieved a clearance of methanol of 239 mL/min (95% confidence interval, 173–305 mL/min), a clearance that is well within the previously published standard of care. We conclude by reviewing both the treatment of toxic alcohol poisoning and the determinants of small molecule clearance with hemodialysis, emphasizing the importance of optimizing the dialytic treatment of intoxications with extended treatment times and the use of high-efficiency dialyzers.

Zingiberales Extract ZE: A Locally Sourced Natural Compound as Gas Hydrate Inhibitor

Gas hydrates are impediments to flow of gas and oil and its avoidance and mitigation is key to oil and gas operators. Mitigation via chemical controls is more suitable for marine environments. The effectiveness of 2wt% of an extract from the plant order, Zingiberales has been compared to that of Mono-Ethylene Glycol in a simulated offshore laboratory mini flow loop of 0.5-inch ID. The results from final pressure shows the value of ZE to be 107 psi while that of the MEG was 99 psi. The ∆P for ZE was 43 psi while that of MEG was 51 psi. The difference in ∆P was 8psi more than that of MEG. The Inhibition Capacity (%) values showed ZE to have performed better with a value of 62.28% while that of MEG was 55.26%. ZE had an Inhibition Capacity that was 7.02% more than that of MEG which is mostly imported and is termed a toxic alcohol, meaning that it is both human and environmentally hazardous. ZE therefore should be considered for development as a gas hydrate inhibitor.

Een patiënte gered door alcohol

A patient saved by alcohol The medical history of a 43-year-old female patient with auto-intoxication of ethylene glycol is reported. Ethylene glycol is a toxic alcohol leading to severe complications if not treated early. Ethylene glycol itself is relatively nontoxic, however life-threatening toxicity appears after metabolization in the liver. These toxic metabolites lead to metabolic acidosis, renal failure, multiple organ failure and death. A quick diagnosis and therapeutic management are important to avoid formation of the metabolites. Serum drug levels give certainty regarding diagnosis, but are rarely available in time to guide management. There is often a strong suspicion or clear history of auto-intoxication. Shortly after large ingestions, patients may present with sedation or inebriation and have a large osmolar gap, but minimal acidosis. After several hours a profound metabolic acidosis with high anion gap will be present. Management involves supportive care, administration of sodium bicarbonate to correct systemic acidosis, inhibition of the enzyme alcohol dehydrogenase with either fomepizole or ethanol, haemodialysis and treatment with cofactors to optimize nontoxic metabolic pathways. Methanol poisoning is also discussed in this article, as methanol is another toxic alcohol with a similar therapeutic management.