Continuous haemodiafiltration compared with intermittent haemodialysis in the treatment of methanol poisoning

Methanol (MeOH) is a toxic alcohol present in many solvents and antifreeze solutions. Ingested MeOH undergoes enzymatic oxidation to toxic formic acid, resulting in acidosis, neurotoxicity and death in severe poisoning. Treatment relies on antidote administration (fomepizole or ethanol) to antagonize MeOH oxidation, folic acid to facilitate the catabolism of formic acid, correction of acidosis and dialysis to accelerate MeOHelimination [1]. Intermittent haemodialysis (HD) is used conventionally [1]. Continuous veno-venous haemodiafiltration (CVVHDF) has not been formally evaluated against this standard. Here we compare the relative efficiencies of HD and CVVHDF in accelerating MeOH elimination and correcting metabolic abnormalities in three severely poisoned patients, seen simultaneously in two tertiary referral hospitals. At that time, only CVVHDF was available in the Intensive Care Department of the hospital that treated two patients. The third patient received HD. Toxicokinetics and clinical outcomes of CVVHDF and HD treated patients were compared.