Hiệu quả của thẩm tách máu kéo dài trong điều trị bệnh nhân ngộ độc cấp methanol

Abstract

Objectives: To evaluate the effectiveness on methanol clearance, correction of metabolic acidosis and outcome of prolonged hemodialysis (HD) in the treatment of acute methanol intoxication, and some complications of this modality. Subjects and Methods: An observational study included 30 patients with methanol poisoning treated by prolonged hemodialysis at the Poison Control Center (PCC), Bach Mai Hospital from January 2016 to June 2017. Results: The mean age was 41.5 ± 14.73 (range: 16-69) years, mostly in the age group of 16-49 years old. The average plasma methanol concentration on admission was 160 mg/dl. After the first prolonged HD (8 hours), the average plasma methanol concentration decreased to 25.51 mg/dl. 14 patients received a second hemodialysis; the plasma methanol concentration after the second hemodialysis was 16.18 mg/dl. Patients presented with severe metabolic acidosis on admission with a median pH of 7.08 (interquartile range: 6.89-7.22). After the first prolonged hemodialysis, the metabolic acidosis was completely improved with a pH of 7.43 (interquartile range: 7.4-7.49). Similarly, HCO3 and BE values were also normalized. Blood lactate levels also significantly improved from 7.94 mmol/L (interquartile range: 3.2-10.6) to 4.06 mmol/L (interquartile range: 2.2-5.02). The mortality rate was 40%. Only 13.33% of patients had a complication, which was bleeding at the catheter site. Conclusion: The study showed the effectiveness and safety of prolonged hemodialysis in the treatment of acute methanol poisoning.