• Sergey Zakharov, Daniela Pelclova, Tomas Navratil, Jaromir Belacek, Jiri Latta, Michal Pisar, Jan Rulisek, Jiri Leps, Pavel Zidek, Cyril Kucera, Robert Bocek, Miroslav Mazur, Zdenek Belik, Josef Chalupa, Viktor Talafa, Kamil Kodras, Daniel Nalos, Ctirad Sedlak, Michal Senkyrik, Jan Smid, Tomas Salek, Darren M Roberts, and Knut Erik Hovda.
• a Department of Occupational Medicine, First Faculty of Medicine , Toxicological Information Centre, Charles University and General University Hospital , Prague , Czech Republic.
• Clin Toxicol (Phila). 2017 Feb 1; 55 (2): 123-132.

ContextAcidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined.ObjectiveWe studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning.MethodsThe study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO3-, 0.01 unit arterial blood pH, and the total time for correction of HCO3- were determined in IHD- and CRRT-treated patients.ResultsData were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p = 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO3- correction correlated with arterial blood pH (r= -0.511; p = 0.003) and creatinine (r = 0.415; p = 0.020). There was association between the time to HCO3- correction and dialysate/effluent and blood flow rates (r= -0.738; p < 0.001 and r= -0.602; p < 0.001, correspondingly). The mean time for HCO3- to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p = 0.024). The mean increase in HCO3- was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001).ConclusionsOur study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.

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