Gouda AS, Khattab AM, Mégarbane B. Lessons from a methanol poisoning outbreak in Egypt: Six case reports. World J Crit Care Med 2020; 9(3): 54-62 [PMID: 32844091 DOI: 10.5492/wjccm.v9.i3.54]
Corresponding Author of This Article
Bruno Mégarbane, MD, PhD, Professor, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, 2 Rue Ambroise Paré, Paris 75010, France. bruno.megarbane@lrb.aphp.fr
Research Domain of This Article
Toxicology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Aug 7, 2020; 9(3): 54-62 Published online Aug 7, 2020. doi: 10.5492/wjccm.v9.i3.54
Lessons from a methanol poisoning outbreak in Egypt: Six case reports
Ahmed S Gouda, Amr M Khattab, Bruno Mégarbane
Ahmed S Gouda, National Egyptian Center of Environmental and Toxicological Research, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Amr M Khattab, Department of Forensic Medicine and clinical Toxicology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Bruno Mégarbane, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris 75010, France
Author contributions: Gouda AS and Khattab AM managed the patients; Gouda AS and Mégarbane B developed the framework of the paper; Gouda AS wrote the first draft; Mégarbane B worked on subsequent drafts; all authors confirmed the last version before submission, and read and approved the final manuscript.
Informed consent statement: The patients gave their written informed consents.
Conflict-of-interest statement: The authors have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bruno Mégarbane, MD, PhD, Professor, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, 2 Rue Ambroise Paré, Paris 75010, France. bruno.megarbane@lrb.aphp.fr
Received: April 6, 2020 Peer-review started: April 6, 2020 First decision: June 8, 2020 Revised: June 8, 2020 Accepted: July 19, 2020 Article in press: July 19, 2020 Published online: August 7, 2020
Abstract
BACKGROUND
Mass methanol poisonings are challenging, especially in regions with no preparedness, management guidelines and available antidotes.
CASE SUMMARY
Six Ukrainian patients were referred to our emergency department in Cairo, Egypt several hours after drinking an alcoholic beverage made of 70%-ethanol disinfectant bought from a local pharmacy. All patients presented with severe metabolic acidosis and visual impairments. Two were comatose. Management was based on the clinical features and chemistry tests due to deficient resources for methanol leveling. No antidote was administered due to fomepizole unavailability and the difficulties expected to obtain ethanol and safely administer it without concentration monitoring. One patient died from multiorgan failure, another developed blindness and the four other patients rapidly improved.
CONCLUSION
This methanol poisoning outbreak strongly highlights the lack of safety from hazardous pharmaceuticals sold in pharmacies and limitations due to the lack of diagnostic testing, antidote availability and staff training in countries with limited-resources such as Egypt.
Core tip: Mass methanol poisoning with unpredictable risk assessment represents a major threat in developing countries. This work reports a clinical series with patients' features and outcome, describes the investigations to identify rapidly the involved causative agent (here, a homemade beverage made with alcoholic disinfectant) and discusses the observed insufficiencies to improve hospital preparedness in case of methanol poisoning outbreak.
