Learnings for EMS from Gujarat Hooch Tragedy

1,537 views
1,364 views

Published on

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,537
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Learnings for EMS from Gujarat Hooch Tragedy

  1. 1. LEARNINGS FOR EMS FROM GUJARAT HOOCH TRAGEDY
  2. 2. • Methanol poisoning is fairly common in our country. *June 2009: Eight die in Orissa's Bolangir *May 2009: 170 die in Karnataka / TN *April-March 2009: Over 30 die at Delhi *January 2009: 23 die in Kolkata • Being cheap, easily available and potent, it is the first adulterant of illicit liquors. • It goes by the names of khopadi, lattha, dalda, bewada, french polish, etc. • Methanol poisoning, whether sporadic or mass poisoning is an acute medical emergency. • If not recognized in time and treated on sound basis of pharmacology and toxicology of this alcohol, it can lead to considerable magnitude of morbidity as well as mortality
  3. 3. Why methanol so dangerous? • The peculiarity of methanol poisoning is the latent period between the ingestion of the alcohol and the appearance of manifestations. • The latency may be related to the concomitant ingestion of ethanol which affects the metabolism of methanol • The symptoms of methanol poisoning are non-specific except for the visual disturbances
  4. 4. Methanol Metabolism Methanol Alcohol dehydrogenase * Formaldehyde Alcohol dehydrogenase Formic Acid C02 H20
  5. 5. Signs & Symptoms • Ocular changes consisting of retinal oedema, blurring of the disc margins, hyperemia of the discs and optic atrophy as a late sequlae are quite characteristic of poisoning. • The terminal event is often respiratory arrest. The fatal period is from 6-36 hours. • Once the symptoms develop they progress at an alarmingly fast rate.
  6. 6. Treatment • Airway, breathing, circulation – ensure adequacy • 3 primary goals of therapy include treatment of: • metabolic acidosis: Inj. Sodium bicarbonate I.V. 1 ml/kg should be administered to correct serum pH • inhibition of the methanol metabolism: Inj. Ethanol 1 ml/Kg/hr for non-alcoholics and higher doses for alcoholics. This is usually not available. Oral Ethanol – 125 ml of Gin, Whisky, or Vodka is an alternative • enhanced elimination of the unmetabolized compound and existing toxic metabolites: Haemodialysis / Folic acid / Antizol • Treatment of serious cardiovascular and neurological signs, such as hypotension and seizures. • Gastric decontamination is UNLIKELY to be beneficial, unless instituted within 1 hour after ingestion.
  7. 7. Treatment contd. The elimination of methanol may be enhanced by the following methods: • Inj. Folic acid 50 mg IV every 4 hours. This is a cofactor in the conversion of formic acid to carbon dioxide. • Haemodialysis is recommended when acidosis is not corrected with Bicarbonate or when optic neuritis is present. • Inj. Antizol (Fomepizole) 15 mg/kg bolus, followed by doses of 10 mg/kg every 12 hours for 4 doses, then 15 mg/kg every 12 hours. All doses should be administered as a slow intravenous infusion over 30 minutes. Fomepizole is a relatively recent safe and effective antidote for ethylene glycol and methanol poisoning. However, should not be used along with ethanol.
  8. 8. Why give alcohol to patient of alcohol poisoning? • The reason you can treat methanol poisoning with ethanol (whisky, gin, vodka etc.) is that ethanol acts as a competitive inhibitor. Ethanol is a competing substrate and so it blocks the conversion of methanol to its toxic products. Competitive inhibitors act by occupying the same site in the enzyme that the substrate occupies thus preventing the substrate from being acted upon by the enzyme
  9. 9. HOW CAN EMS HELP? • All scientific reports on methanol poisoning have associated high mortality to the delay in the treatment • Early activation of MCI protocol • Choose destination hospitals with adequate capability (haemodialysis / beds / ICU) and competency. • Single most effective intervention that can be done in pre hospital care setup is: GIVE IV / ORAL ALCOHOL (ethanol)

×