Abstract
Methyl alcohol poisoning was frequent after the Second World War but has become rare. After hemodialysis (H. D.) was introduced in Japan, only one case of methyl alcohol poisoning treated with H. D. was reported (Kan et al. 1979). Gonda et al. reviewed the worldwide literature in English and reported 35 cases of methyl alcohol intoxication treated with H. D. 1961-1978. Our case seems to be the second case of methyl alcohol intoxication treated with H. D. in Japan.
The patient, a 34-year-old sailor, ingested approximately 250cc. of methyl alcohol diluted with water after consuming six bottles of beer. He developed headache and visual disturbance and became comatose. On arrival at the hospital, he was in shock and developed respiratory arrest, which was treated successfully. The arterial blood pH was 6.7, HCO3 was 6mEq/l and anion gap 40.
The patient received H. D. for five hours, using 1.1M2 of hollow fiber. We administered 1800cc. of 7% NaCO3 intravenously, combined with ethanol ingestion through a stomach tube intermittently. The blood methyl alcohol level was 258mg/dl on arrival and dropped to 48mg/dl after five hours of H. D. The patient's temperature rose to 42°C. and he developed congestive heart failure. He expired the following day.
In this case, there was a long interval from ingestion of methyl alcohol to treatment, and metabolic acidosis was remarkably severe. These two factors seem to explain why we failed to save the patient.
