美国临床毒理学在甲醇中毒的治疗实践指南。

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Barceloux DG、债券GR、Krenzelok EP,库柏H,淡水河谷农协

美国临床毒理学在甲醇中毒的治疗实践指南。

40 J Toxicol Toxicol。2002; (4): 415 - 46。

PubMed ID
12216995 (在PubMed
]
文摘

流行病学:几乎所有急性甲醇中毒病例由于摄入,虽然很少中毒病例是吸入或皮肤吸收。甲醇口服后迅速吸收和甲醇浓度峰值出现在30-60minutes。毒性的机制:甲醇的毒性相对较低和新陈代谢负责甲醇的变换其有毒代谢产物。甲醇被乙醇脱氢酶氧化甲醛。甲酸的甲醛氧化是通过甲醛脱氢酶。甲酸被10-formyl转换tetrahydrofolate合成酶,二氧化碳和水。在甲醇中毒的情况下,甲酸积累和甲酸浓度有直接相关性,增加发病率和死亡率。甲醇中毒的酸中毒观察似乎是直接或间接由甲酸生产引起的。甲酸也已被证明能够抑制细胞色素氧化酶是眼毒性的主要原因,尽管酸中毒可增加毒性进一步通过允许更大的甲酸扩散进入细胞。特点:甲醇中毒通常引起恶心、呕吐、腹痛、抑郁和温和的中枢神经系统。 There is then a latent period lasting approximately 12-24 hours, depending, in part, on the methanol dose ingested, following which an uncompensated metabolic acidosis develops and visualfunction becomes impaired, ranging from blurred vision and altered visual fields to complete blindness. MANAGEMENT: For the patient presenting with ophthalmologic abnormalities or significant acidosis, the acidosis should be corrected with intravenous sodium bicarbonate, the further generation of toxic metabolite should be blocked by the administration of fomepizole or ethanol and formic acid metabolism should be enhanced by the administration of intravenous folinic acid. Hemodialysis may also be required to correct severe metabolic abnormalities and to enhance methanol and formate elimination. For the methanol poisoned patient without evidence of clinical toxicity, the first priority is to inhibit methanol metabolism with intravenous ethanol orfomepizole. Although there are no clinical outcome data confirming the superiority of either of these antidotes over the other, there are significant disadvantages associated with ethanol. These include complex dosing, difficulties with maintaining therapeutic concentrations, the need for more comprehensive clinical and laboratory monitoring, and more adverse effects. Thus fomepizole is very attractive, however, it has a relatively high acquisition cost. CONCLUSION: The management of methanol poisoning includes standard supportive care, the correction of metabolic acidosis, the administration of folinic acid, the provision of an antidote to inhibit the metabolism of methanol to formate, and selective hemodialysis to correct severe metabolic abnormalities and to enhance methanol and formate elimination. Although both ethanol and fomepizole are effective, fomepizole is the preferred antidote for methanol poisoning.

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