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Methanol Poisoning

Management of Methyl Alcohol Poisoning

Methanol or Methyl Alcohol is a denaturant. It is a component of varnishes, paint removers, windshield wipers, anti-freeze solutions, copy-machine fluid and as a solvent.

Acute Poisoning

Acute Methanol Poisoning is usually a consequence of ingestion of cheap, adulterated, illicit liquor. Methanol is very toxic and requires as little as 30 ml of 40% solution to be fatal. Poisoning is mostly stratified among the people of lower socioeconomic status. On ingestion, Methanol is metabolized in the liver to formaldehyde and formic acid by alcohol dehydrogenase. Although both are toxic, formic acid is what causes the more serious delayed effects. It is also readily distributed in the liver, gastrointestinal tract, eyes and kidneys.

Clinical Features

Methanol is rapidly absorbed from the gastrointestinal tract, peak levels reaching within 1-2 hours. Onset of clinical manifestations is variable.

Early manifestations such as nausea, vomiting, headache, vertigo and gastritis are primarily caused by Methanol itself. High serum levels of Methanol (>40 mg/dl) is associated with obtundation, convulsions and coma.

Late manifestations such as visual disturbances, severe metabolic acidosis, seizures, coma and death are common after 30 hours after ingestion. The latent period is longer when Ethanol is ingested concurrently. Ocular toxicity is associated with diminished vision, flashing spots, dilated pupils, optic disc hyperemia, retinal edema and ultimately blindness.

Severe poisoning leads to myocardial depression, bradycardia and shock.

Laboratory Investigations

Apart from arterial blood gases which is essential, serum osmolality and anion gap assist in diagnosis. Renal and Liver function tests should be done and blood Methanol levels measured, if possible. CT scan of the brain may show bilateral putamen necrosis. A retrospective diagnosis of Methanol poisoning is sometimes based on this finding. Diagnosis is essentially clinical, but calculation of the osmolal and anion gap can help assess severity where serum methanol levels cannot be estimated.

Treatment

1. Unabsorbed Methanol should be removed by gastric lavage.

2. Supportive Measures:

  • Correction of Acidosis
  • Control of seizures
  • Maintenance of nutrition
  • Alkalization of urine enhances excretion of formic acid

3. Specific Measures:

  • Administration of Ethanol to saturate alcohol dehydrogenase in the liver, preventing the formation of toxic metabolite, formaldehyde. A 5% solution of Ethanol is prepared and 15 ml/kg is given as loading dose and then 2-3 ml/kg/hour as maintenance dose orally. It can also be given intravenously.
  • Hemodialysis enhances elimination of Methanol and Formic acid and is indicated when Methanol levels exceed 50 mg/dl. In the absence of serum Methanol level measurements, the osmolar gap is useful to assess the indication for and duration of hemodialysis in Methanol-poisoned patients.
  • Folic acid has been used to enhance conversion of formate to carbon dioxide and water. The dose is 50 mg IV 4 hourly for 24 hours.
  • 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, has been successfully used as an alternative to Ethanol and Dialysis.
BP Apparatus

Discovery of Indirect Blood Pressure Measurement

Most medical discoveries have a notable story to tell. So it is with the discovery of Blood Pressure Measurement. This as I feel is one of the most important discoveries in medical science. With the rise in incidence of hypertension, cerebrovascular accidents, and heart failure, it is only apt that I brought out this interesting history about the past.

The Guys who made it possible

Riva Rocci invented the mercury manometer – this led to the dissemination of indirect sphygmomanometry for systolic pressure. Riva Rocci was the pupil of Potain, the great Parisian diagnostician who is attributed with introduction of the sphygmomanometer. Once Korotkoff had discovered the sounds known by his name, for diastolic as well, the history of the discovery of Indirect Blood Pressure Measurement was complete.

Korotkoff was a surgeon in the Czar’s army and not an internist as was believed earlier. Pirogoff, his teacher, had taught him always to auscultate over any area before performing an incision. On one occasion, while auscultating over an artery just as he was releasing a tourniquet, he heard thumping sounds. Abandoning his original scientific problem which was to study posttraumatic arteriovenous fistulas in the surgical dog laboratory, he tried to quantitate the amount of pressure required to make these auscultated sounds appear and disappear. The sounds correlated well with systole and diastole, as could be ascertained by direct inspection of the flow of blood from the distally severed artery of the dog.

Like most revolutionary discoveries, this landmark discovery was no alien to alienation. When Korotkoff first reported his findings in humans, some considered he had gone bonkers! So were many other scientists and innovators.

IBS

Irritable Bowel Syndrome – Symptoms, Causes and Treatments

Irritable bowel syndrome is a chronic functional disorder of the intestines which causes abdominal pain, often accompanied by cramping, bloating, diarrhea and constipation. It is also referred to as spastic colon or mucous colitis. Irritable bowel syndrome is more commonly known by its abbreviated term – IBS.

There are three forms of IBS depending on the symptoms — diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) and IBS with alternating stool pattern (IBS-A). Clinical investigations are going on a new IBS subtype, post-infectious IBS (IBS-PI).

Symptoms of IBS

[box]IBS symptoms include: • Abdominal pain • Discomfort associated with changes in bowel habits • Fewer than three bowel movements a week • More than three bowel movements a day • Hard or lumpy stools • Loose or watery stools • Straining during a bowel movement • Urgency (having to rush to have a bowel movement) • Feeling of incomplete bowel movement • Passing mucus (white material) during a bowel movement • Abdominal fullness, bloating, or swelling • Chronic pelvic pain • Mental stress • Fibromyalgia and various mental disorders • Researchers believe that there are neurological and psychological disorders associated with IBS.[/box]

Causes of Irritable Bowel Syndrome

The exact causes of irritable bowel syndrome are unknown, but there are factors that may aggravate the trouble. Dietary factors and stress don’t exactly cause IBS, but they can aggravate it. Various studies and researches have noted an IBS connection to diet. Physicians feel that the correct diet can provide IBS relief.

Common IBS diet advice includes:

• Eat soluble fiber foods and supplements.
• Substitute dairy products for soy or rice products.
• Be careful with fresh fruits and vegetables that are high in insoluble fiber.
• Eat small amounts in regular intervals to lessen the symptoms of IBS.
• Avoid eating red meat, oily or fatty (and fried) products.
• Avoid taking dairy products (especially when lactose intolerance is suspected).
• Avoid solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages and artificial sweeteners.

IBS Treatment

IBS treatment includes dietary advice and medication. Developing good dietary habits may be the best treatment for irritable bowel syndrome.

Medications can provide instant IBS relief. These may include stool softeners and laxatives in constipation-predominant, and antidiarrheal (loperamide) in diarrhea-predominant IBS. The low dosage of tricyclic and SSRI antidepressants has shown to be the most widely prescribed medications for helping to relieve symptoms of visceral sensitivity (pain) and diarrhea or constipation respectively. Other medications include:

• Alosetron: Alosetron is a selective 5-HT3 antagonist for IBS-D. It is only available for women in the United States under a restricted access program, due to severe risks of side effects if taken mistakenly by IBS-A or IBS-C sufferers.

• Cilansetron: Cilansetron is also a selective 5-HT3 antagonist that is undergoing further clinical studies in Europe for IBS-D sufferers.

• Tegaserod: Tegaserod is a selective 5-HT4 antagonist for IBS-C. It has shown to have an excellent safety profile for relieving IBS constipation and chronic idiopathic constipation.

Medical Island Collage

Medical Island gets a Makeover!

Welcome to Medical Island – the place for Health Freaks and Medicos to chill out!

Thanks to The Amazing Thesis Theme for WordPress by Chris Pearson and my own customization, Medical Island has a new look and flavour!

With more zest and life put into the new website, the authors at Medical Island are here to provide you with unique and excellently written articles on healthcare and tutorials to prepare healthcare professionals for various exams.

Hoping that the articles provided in this site will help you in your practice and the humorous articles to cheer you up!

Regards,

Dr. Lawrence Kindo

Founder and CEO, www.medicalisland.net

[box type=”important”]I believe in a fresh makeover and hence I am starting the blog from scratch. Of course the older articles will be posted soon. Watch out![/box]

Doctor Vs. Mechanic Joke

Doctor Vs. Mechanic

Morris was removing some engine valves from a car on the lift when he spotted the famous heart surgeon Dr. Michael DeBakey, who was standing off to the side, waiting for the service manager. Morris, somewhat of a loud mouth, shouted across the garage, “Hey DeBakey… Is dat you? Come over here a minute.”

The famous surgeon, a bit surprised, walked over to where Morris was working on a car. Morris in a loud voice, all could hear, said argumentatively, “So Mr. fancy doctor, look at this work. I also take valves out, grind ‘em, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when you and me are doing basically the same work?”

DeBakey, very embarrassed, walked away and said softly, to Morris, “Try doing your work with the engine running.”

Medical Record Bloopers

Medical Record Bloopers

A list of blunders and funny incidents in a medical person’s life:

  1. The skin was moist and dry.
  2. Rectal exam revealed a normal size thyroid. (Long fingers?)
  3. The patient had waffles for breakfast and anorexia for lunch.
  4. She stated that she had been constipated for most of her life until 1989 when she got a divorce.
  5. Between you and me, we ought to be able to get this lady pregnant.
  6. The patient was in his usual state of good health until his airplane ran out of gas and crashed.
  7. The lab test indicated abnormal lover function.
  8. The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.
  9. Exam of genitalia reveals that he is circus sized.
  10. I saw your patient today, who is still under our car for physical therapy.
  11. The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.
  12. Bleeding started in the rectal area and continued all the way to Los Angeles.
  13. Both breasts are equal and reactive to light and accommodation. (Excuse me, what are you doing with that pen light?)
  14. She is numb from her toes down.
  15. Exam of genitalia was completely negative except for the right foot. (Anatomy review time!)
  16. While in the emergency room, she was examined, X-rated and sent home.
  17. The patient was to have a bowel resection. However, he took a job as a stockbroker instead. (An empowered patient.)
  18. The patient suffers from occasional, constant, infrequent headaches.
  19. Coming from Detroit, this man has no children.
  20. Examination reveals a well-developed male lying in bed with his family in no distress.
  21. Patient was alert and unresponsive.
  22. When she fainted, her eyes rolled around the room.
  23. We will follow her eyes and nose with a foley catheter.
  24. By the time he was admitted, his rapid heart had stopped, and he was feeling better.
  25. Patient has chest pain if she lies on her left side for over a year.
  26. On the second day the knee was better and on the third day it had completely disappeared.
  27. The patient has been depressed ever since she began seeing me in 1983.
  28. The patient is tearful and crying constantly. She also appears to be depressed.
  29. Discharge status: Alive but without permission.
  30. Healthy-appearing decrepit sixty-nine-year-old male, mentally alert but forgetful.
  31. The patient refused an autopsy.
  32. The patient expired on the floor uneventfully.
  33. Patient has left his white blood cells at another hospital.
  34. The patient’s past medical history has been remarkably insignificant, with only a forty-pound weight gain in the past three days.
  35. She slipped on the ice and apparently her legs went in separate directions in early December.
  36. The patient had a rash over his truck.
  37. Dictation blunder: lasar radar response (as opposed to vagovagal response).

[box type=”spacer”]Loved these bloopers. I am sure you might have some interesting ones too. Just add yours to the comments below and I will update this list.[/box]
Medical Bloopers

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