When is hemodialysis indicated in the treatment of metabolic acidosis and methanol or ethylene glycol poisoning?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Hemodialysis should be considered in any patient with significant metabolic acidosis, renal failure, visual symptoms, a high blood toxin level, or a suspected large overdose. Hemodialysis is effective in clearing methanol and ethylene glycol, as well as their toxic metabolites; in correcting the acidosis; and in restoring extracellular volume.

A study by Zakarov et al of 31 patients involved in a mass outbreak of methanol poisoning determined that correction of acidemia was accomplished more rapidly with intermittent hemodialysis (IHD) than with continuous renal replacement therapy (CRRT). HCO3- increased by 1 mmol/L in a mean of 12 ± 2 min with IHD versus 34 ± 8 min withr CRRT (P <  0.001), while arterial blood pH increased 0.01 in a mean of 7 ± 1 mins with IHD versus 11 ± 4 min with CRRT (p = 0.024). [26]

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