Methanol Poisoning: Ocular and Neurological Manifestations; An Experience Of Outbreak

1.Ranjana Sharma¹
2. Sanjay Marasini¹
3. Anand Kumar Sharma²
4. Bhagawat Prasad Nepal¹

¹Kathmandu University Hospital, Dhulikel, Nepal
²Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Purpose
In Nepal, alcohol consumption is deep rooted because of cultural and traditional values and alcohol production contributes more than 50% of total excise duty. The consumption of contaminated products leads to severe metabolic acidosis and cellular dysfunction with neurological, gastrointestinal and visual deficit. We conducted this study to evaluate the efficacy of ethanol and high dose intravenous methylprednisolone in acute methanol poisoning. Fomepizole considered a standard therapeutic modality is not available in our centre and this study was conducted without its use.

Methods
Eight cases of acute methanol poisoning presented to the emergency department. Neurological and ocular examination including visually evoked potential and electroretinography (in 4 patients) was conducted at admission. All patients were treated with methylprednisolone intravenously. Ethanol was given intravenously in four cases who presented within 48 hours. Hemodialysis was performed in two cases having neurological manifestation and metabolic acidosis. Sodium bicarbonate was given to four patients. Folinic acid and multivitamins were added to all the patients. Regular follow up visits were conducted.

Result
All patients had visual symptoms. Pupillary abnormality was observed in all patients. Edema of the optic disc and nerve fiber layer were the common fundus findings
Most of the patients showed good response to the treatment. Two line improvements in visual acuity in followed up cases were noted in 87.5%.

Conclusion
Early presentation with prompt treatment has a significant role to reserve and to improve visual acuity. Ethanol and high dose intravenous methylprednisolone can be an alternative treatment where fomepizole is unavailable.