Abstracts of the Toxicology and Poisons Network Australasia (TAPNA) 2024 Annual Scientific Meeting (Melbourne, Victoria) 1. Management of toxic alcohol poisoning in New South Wales: a retrospective study

• Published in: Toxicology communications Vol. 8; no. 1
• Main Authors: Mullins, Michael E., Beaulieu, Jessie, Chandru, Pramod, Berling, Ingrid, Chan, Betty, Roberts, Darren
• Format: Journal Article
• Language: English
• Published: Taylor & Francis Group 31.12.2024
• ISSN: 2473-4306; 2473-4306
• DOI: 10.1080/24734306.2024.2372936

Background Toxic alcohol poisoning is uncommon in New South Wales (NSW). Inadequate treatment causes significant morbidity and mortality. Management priorities are diagnosis, and early treatment with alcohol dehydrogenase (ADH) blockade and extracorporeal treatments (ECTRs). Fomepizole is a potent ADH inhibitor available in Australia but its use and role, compared to ethanol, is uncertain. We describe the epidemiology, management and outcomes of suspected significant toxic alcohol poisonings in NSW.Methods We searched databases of the NSW Poisons Information Centre, five tertiary clinical toxicology services and Statewide retrieval services. We included all patients with known or suspected toxic alcohol poisoning referred to a clinical toxicologist and included all patients who received treatment with ADH blockade. Patients were subdivided on the basis of whether toxic alcohol poisoning was confirmed or excluded. Data extracted included demographics, details of the exposure, management (including treatment delays and monitoring of ethanol therapy (if received), outcomes and complications). Categorical data were described as frequencies and percentages, and continuous data were described as median and interquartile ranges.Results Among 198 patients between 2015 and 2023, 36 fulfilled inclusion criteria. Toxic alcohols ingested included ethylene glycol (29), diethylene glycol (5), and methanol (1); 12 co-ingested ethanol. Toxic alcohol poisoning was confirmed by history or specific assays in 35 cases. Delay to presentation was median 3 h (IQR 2–9; 20). Delay from hospital presentation to initiating ADH blockade was median 3 h (IQR 2–7; 27). Three were diagnosed after developing unexplained AKI. Four patients received fomepizole and 27 received ethanol therapy. In the 20 patients who received ethanol for ≥24 h, blood ethanol concentrations were measured median 5.5 times (IQR 4-11) in the first 24 h, and 9 had at least 2 subtherapeutic levels. 21 patients received ECTR, which was initiated within median 7 h (IQR 4-11). Excluding 3 patients who did not receive treatment due to delayed diagnosis, 18 developed complications (acute kidney injury 16, neurotoxicity 8, death 3). In 18 ethanol-treated patients, fomepizole would have offered key advantages, including avoiding ICU (9), facilitating transport (7), and delaying and/or foregoing ECTR (6).Discussion There are potential benefits of fomepizole use in NSW.