Severe methanol poisoning treated with a novel hemodialysis system: a case report, analysis, and review.
Alisa C Illescas, Christos P Argyropoulos, Sara A Combs, Saeed K Shaffi, Zhi Q Xu, Michael A Aragon, J Pedro Teixeira
Author Information
Alisa C Illescas: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA.
Christos P Argyropoulos: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA. ORCID
Sara A Combs: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA. ORCID
Saeed K Shaffi: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA. ORCID
Zhi Q Xu: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA.
Michael A Aragon: Outset Medical, 3052 Orchard Drive, San Jose, CA 95134 USA.
J Pedro Teixeira: Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA. ORCID
In May and June 2020, an outbreak of methanol poisoning arose in the southwest United States linked to ingestion of contaminated hand sanitizer imported during the coronavirus disease 2019 pandemic, ultimately resulting in over a dozen hospitalizations and at least four deaths in New Mexico and Arizona. In this report, we describe one of these cases in which profound methanol intoxication was successfully treated with the Tablo® Hemodialysis System, the first reported case of toxic alcohol poisoning treated with this novel device. We carry out a formal regression analysis of the serial methanol levels obtained in this case to conservatively estimate that intermittent hemodialysis with Tablo achieved a clearance of methanol of 239 mL/min (95% confidence interval, 173-305 mL/min), a clearance that is well within the previously published standard of care. We conclude by reviewing both the treatment of toxic alcohol poisoning and the determinants of small molecule clearance with hemodialysis, emphasizing the importance of optimizing the dialytic treatment of intoxications with extended treatment times and the use of high-efficiency dialyzers.
