Predictors of Mortality in Methanol Poisoning: A Systematic Review and Meta-analysis

Background: Today, methanol intoxication is increasing. Identifying mortality predictors has a significant correlation with poisoning progress. This meta-analysis study aimed to identify and evaluate mortality predictors for methanol poisoning.Methods: In this study, we searched electronic databases for case-control and cohort studies related to methanol poisoning. The quality of the studies was evaluated using the STROBE checklist. Comprehensive meta-analysis 3 was used to calculate the odds ratio (OR) and 95% CI of the factors present, as well as to perform heterogeneity, sensitivity, and publication bias assessments.Results: In this meta-analysis study, 14 out of 945 initial studies were included. The results identified 15 mortality predictors of methanol poisoning. The risk factors were ranked by the integrated OR values and included venous blood pH (OR=3.79, 95% CI, 2.42%, 5.19%), methanol concentration (OR=1.64, 95% CI, 1.05%, 2.55%), venous carbon dioxide pressure (PCO2) (OR=9.993, 95% CI, 5.80%, 17.18%), base deficit (OR=2.943, 95% CI, 1.20%, 7.165%), hemodialysis time (OR=2.69, 95% CI, 1.35%, 5.35%), blood sugar (OR=9.84, 95% CI=3.86, 25.09), venous bicarbonate (HCO3) (OR=2.97, 95% CI, 1.68%, 5.26%), creatinine (OR=13.10, 95% CI, 2.68%, 64.04%), potassium (K) (OR=3.51, 95% CI, 1.66%, 7.43%), alanine aminotransferase (OR=7.57, 95% CI, 1.03%, 55.57%), sodium (OR=6.69, 95% CI, 1.78%, 25.12%), white blood cells (OR=7.16, 95% CI, 1.42%, 36.16%), coma (OR=32.73, 95% CI, 18.59%, 56.70%), visual disturbances (OR=3.37, 95% CI, 1.59%, 7.16%), and gastrointestinal symptoms (OR=1.94, 95% CI, 1.16%, 3.22%).Conclusion: Identifying mortality predictors and disease progression in methanol intoxication patients can help doctors diagnose patients at risk better and faster to provide effective treatment interventions for them

Dose-Dependent Effects of Methadone on QT interval in Patients under Methadone Maintenance Treatment

Background: The role of methadone in QTc prolongation, Torsades de Pointes (TdP) arrhythmia and sudden cardiac death has been debated. Because of widespread use of methadone in methadone maintenance treatment (MMT) centers, we aimed to study dose-related effects of methadone on QTc prolongation. Methods: In a comparative observational study, 90 patients who were under MMT were evaluated. Patients were divided into three groups according to methadone daily dose (G1: 0-59 mg, G2: 60-109 mg, G3: 110-150 mg). Twelve-lead electrocardiograms (ECG) were performed at baseline and two months later, after reaching the maximum daily dose of methadone. The QTc were calculated for each patient. Comparison of mean QTc and mean QTc prolongation between baseline and follow up ECGs were analyzed. Results: In total, mean (SD) age was 32.4 (8.5). TdP was not detected in any patients. Mean QTc was 405.2 (17.0) and 418.5 (23.1) msec before and two months after MMT respectively. There was a significant difference between mean QTc in each group before and after treatment (

Allergic reaction to intravenous atropine in a patient with organophosphate poisoning

Atropine is a drug of choice for muscarinic effects in organophosphate (OP) poisoning. Allergic reaction to atropine is rare. Here, we report a case of a 17-year-old male who was admitted with clinical manifestations of acute OP poisoning. After intravenous atropine injection, cutaneous signs of hypersensitivity including erythema and urticarial were observed on his body. Atropine injection was stopped, and antihistamines and hydrocortisone were administered. His condition was improved, and he discharged with a good condition after 2 days hospitalization. Adverse allergic reaction to atropine should be in mind when managing OP poisoning cases

Evaluation of serum sodium changes in tricyclic antidepressants toxicity and its correlation with electrocardiography, serum pH, and toxicity severity

Background: Tricyclic antidepressants (TCAs) is a group of drugs used for the depression treatment. One of the effects of these drugs is Na (sodium) channel blocking ability causing cardiac complications such as ventricular tachycardia and Torsades de pointes Arrhythmia. Sodium bicarbonate is used for treatment of these complications which may have some effect on serum sodium levels. Considering no specific research on Na changes on these patients, the serum Na changes and its correlation with ECG changes, serum pH, and TCA toxicity severity were evaluated. Materials and Methods: A prospective descriptive-analytic cross-sectional study was done on TCA-poisoning patients who were admitted in Noor hospital in Esfahan in last 2 years. Serum sodium levels, ECG changes, and TCA severity toxicity of 92 patients were evaluated five times during first 24 h of admission. Results: A total of 92 patients were studied. The most common symptoms were conscious level changes (81.52%) and mydriasis (64.1%). Based on toxicity severity by these symptoms the patients were classified into three groups: 12% of the patients had mild toxicity, 50% moderate, and 38% severe toxicity. There were no significant differences in mean serum Na during the time. There was not found any correlation between serum Na level, and serum pH, ECG, and toxicity severity. Conclusions: Using sodium bicarbonate in TCA-poisoning cases does not change the serum Na levels significantly