Prognostic factors in patients with methanol poisoning

Objective: To identify prognostic factors in methanol poisoning and determine the effect of medical interventions on clinical outcome. Methods: Retrospective review of all patients treated for methanol poisoning from 1982 through 1992 at The Toronto Hospital. Presenting history, physical examination, results of laboratory tests, medical interventions, and final outcomes after hemodialysis were abstracted. Results: Of 50 patients treated for methanol poisoning, 18 (36%) died, 32 (64%) survived. Seven of the 32 survivors sustained visual sequelae (22%), the remaining 25 (78%) recovered completely. Patients presenting with coma or seizure had 84% (16/19) mortality compared to 6% (2/31) in those without (p < 0.001). Initial arterial pH < 7 was also associated with significantly higher mortality (17/19, 89% vs 1/31, 3%, p < 0.001). There were no differences in time from presentation to dialysis between survivors and fatalities (8.4 +/- 3.6 vs 7.6 +/- 3.5 hours, p = 0.47). The deceased patients had higher mean methanol concentration than the survivors (83 +/- 53 vs 41 +/- 25 mmol/L, p = 0.004). Subgroup analysis of 19 patients presenting with visual symptoms who survived showed prolonged acidosis (5.4 +/- 2.3 vs 3.0 +/- 2.1 hours, p = 0.06) in those with persistent visual sequelae. Conclusions: Coma or seizure on presentation and severe metabolic acidosis, in particular initial arterial pH < 7, are poor prognostic indicators in methanol poisoning. Survivors presented with lower methanol concentrations. Patients with residual visual sequelae had more prolonged acidosis than those with complete recovery. Future studies will be needed to confirm the effect of correction of acidosis on final clinical outcome.