Adverse reactions to hemodialysis in 72 cases of toxic alcohol poisoning

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2005-10, Vol.43 (6), p.676-676
• Main Authors: Lepik, K J, Purssell, R A, Levy, A R, Daws, DE
• Format: Article
• Language: English
• ISSN: 1556-3650

Methanol (ME) and ethylene glycol (EG) poisoning are treated with antidote to block formation of toxic metabolites and hemodialysis (HD) to remove toxins and provide renal support. In cases with moderately elevated toxic alcohol levels and no acidosis or renal failure, clinicians must weigh the risks and benefits of treating with antidote alone, or administering HD to enhance toxin elimination. HD-related morbidity has not been characterized in toxic alcohol poisoning. Our objective was to estimate incidence and severity of HD-related adverse reactions (ARs) in the treatment of ME and EG poisoning. We performed a 5 year retrospective review of hospital admissions for ME and EG poisoning from 1996-2001. Cases at 9 hospitals with HD facilities were identified by ICD-9 codes 980.1 (ME) and 982.8 (EG) and were included if they received HD to enhance elimination of ME or EG or correct metabolic acidosis. HD sessions given solely for support of renal failure were not included. ARs were defined as symptoms temporally associated with HD and not attributable to another cause. Procedure complications (e.g. clogged lines) were recorded if HD was interrupted >30 minutes. Seventy two cases (38 ME, 34 EG) received HD, all of whom were also treated with ethanol antidote. There were 9 adolescents and 63 adults. Median age was 35 years, 69% were male. A mean (sd) of 1.5 (1.0) HD sessions were used per case at 6.3 (3.5) hours per session. Twenty patients (28%) experienced a HD-related AR: Ten had procedure interruptions >30 minutes, but these did not appear to affect case outcome. Seven had pain or transient bleeding at the catheter site. Three patients developed hypotension: 2 required no treatment, 1 needed pressors. One patient suffered an arterial tear during catheter insertion leading to internal bleeding, shock and cardiac arrest with eventual recovery. There were no serious ARs due to heparinization. Two patients (3%) in this series experienced serious HD-related adverse events, one of which was life-threatening. The decision to employ HD for enhancing ME or EG elimination in the absence of other indications must be weiged against the risks of the procedure.