Ölümün De Rengi Var, Bu Sefer Mor; Metanol

Giriş: Metanol, metabolitleri tarafından toksik olan ve ahşabın damıtılmasıyla elde edilen renksiz, kokusuz bir alkol türüdür.Olgu: 64 yaşında kadın hasta, son bir aydır çift görme, denge kaybı ve 2 hafta boyunca beslenme kaybı, başvuru günü ise uyuşukluk ile ilgili soruları cevaplamada güçlük şikayetleri ile acil servisimize başvurdu. Ekstremitelerinde pembe-mor hiperemi vardı ve her iki dizde de yaygın dermatit düşünüldü. Hikâyede diz ağrısı için odun alkolünün topikal olarak uygulandıktan sonra dizlerde dermatit geliştiği öğrenildi ve hastaya metanol zehirlenmesi teşhisi kondu. Bilincin bozulması üzerine entübasyon kararı verildi ve hastanemizin anestezi ve reanimasyon ünitesinde entübe olarak hemodiyaliz yapıldı. Yoğun bakım ünitesine yatışından 3 gün sonra kardiyak arrest gelişti ve hasta ex oldu.Tartışma: Anyon boşluğu artmış metabolik asidoz vakalarında, nedeni açıklanamayan, metanol toksisitesinin ihmal edilmemesi ve bu durumun ölümcül olabilmesini hatırlatmayı amaçladık.
Anahtar Kelimeler:

Metanol, metabolik asidoz, dermatit

Death also have color, this time purple; Methanol

Introduction: Methanol is a colorless and odorless alcohol type that is toxic by its metabolites and is obtained by distillation of wood.Case Report: A 64-year-old female patient was admitted to our emergency department with complaints of double vision, difficulty in answering questions and drowsiness. Her extremities had pink-purple hyperemia, suggesting widespread dermatitis in both knees. It was found that dermatitis developed after the patient was applied wrapping from wood alcohol for knee pain, and the patient was diagnosed with methanol poisoning. Upon the disruption of her consciousness, an intubation decision was made and hemodialysis was performed in the anesthesia and reanimation unit of our hospital while the patient was intubated. After 3 days of her hospitalization in the intensive care unit, the patient was exitus with a development of cardiac arrest.Discussion: We aimed to remind you that in metabolic acidosis cases with increased anion gap, methanol toxicity is a reason that should not be neglected and may be fatal.

___

  • 1. Gok E, Horoz M, Turgutalp M, Kıykım AA. Fatal Transdermal Methanol Intoxication: A Case Report and Review of Literature. Turkiye Klinikleri J Med Sci. 2011;31(1):234-9
  • 2. Koprulu AS, Sener T, Sungar D, Turunc V, Kalfaoglu E. Accidental Transdermal Methanol Poisoning: Diffificulties and Suggestions in Therapy Case Report. Turkiye Klinikleri J Case Rep. 2016;24(1):89-92
  • 3. Chu J, Wang RY, Hill NS. Update in clinical toxicology. Am J Respir Crit Care Med. 2002;166(1):9-15.
  • 4. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila) 2007;45(2):152-7
  • 5. Benton CD Jr, Calhoun EP Jr. The ocular effects of methyl alcohol poisoning; report of a catastrophe involving 320 persons. Am J Ophthalmol 1953;36(12):1677-85.
  • 6. Karaduman F, Asil T, Balci K, Temizoz O, Unlu E, Yilmaz A, et al. Bilateral basal ganglioniclesions due to transdermal methanol intoxication. J Clin Neurosci 2009;16(11): 1504-6.
  • 7. Yayci N, Ağritmiş H, Turla A, Koç S. Fatalities due to methyl alcohol intoxication in Turkey:an 8-year study. Forensic Sci Int 2003;131(1): 36-41.
  • 8. Batterman SA, Franzblau A. Time-resolved cutaneous absorption and permeation rates ofmethanol in human volunteers. Int Arch Occup Environ Health 1997;70(5):341-51.
  • 9. Soysal D, Yersal Kabayegit O, Yilmaz S, Tatar E, Ozatli T, Yildiz B, et al. Transdermal methanol intoxication: a case report. Acta Anaesthesiol Scand 2007;51(6):779-80.
  • 10. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA; 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 2002;40(4):415-46.
  • 11. Mégarbane B, Borron SW, Baud FJ. Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med 2005;31(2):189-95.
  • 12. Hovda KE, Froyshov S, Gudmundsdottir H, Rudberg N, Jacobsen D. Fomepizole may change indication for hemodialysis in methanol poisoning: prospective study in seven cases. Clin Nephrol 2005;64(3):190-7.