Table 2.
Treatment events including hemodialysis prescription
| Day | Time | Methanol levels (mmol/L) | Events |
|---|---|---|---|
| 1 | 11:35 | Fomepizole given at local ED. | |
| 1 | 16:40 | > 156 | |
| 1 | 20:56 | Treatment #1 started. Tablo® machine, Revaclear™ dialyzer, right IJ 15-cm 12-French Power-Trialysis™ catheter, lines reversed, Qb 350 mL/min, Qd 300 mL/min, UF 75 mL/h. | |
| 1 | 22:15 | Circuit clotted. | |
| 1 | 22:44 | Restarted with circuit lines changed and in-line heparin† added. Qb 300 mL/min, Qd 300 mL/min. | |
| 1 | 22:45 | Fomepizole 950 mg IV. | |
| 1 | 23:05 | Due to poor flows, Qb dropped further to 250 mL/min. | |
| 1 | 23:14 | Treatment stopped again. Unable to aspirate from either line. New vascular access placed (right femoral 30-cm Power-Trialysis catheter). | |
| 2 | 0:45 | Fomepizole 950 mg IV. | |
| 2 | 0:56 | Treatment restarted using femoral line. Qb 350 mL/min, Qd 300 mL/min, UF 200 mL/h. | |
| 2 | 4:04 | Treatment #1 completed. | |
| 2 | 7:51 | 64.9 | |
| 2 | 9:19 | Fomepizole 1500 mg IV. | |
| 2 | 10:45 | Treatment #2 started. Tablo machine, Revaclear dialyzer, access 1-and-1 (right IJ arterial, right femoral venous return), Qb 350 mL/min, Qd 300 mL/min, UF 337 mL/h. | |
| 2 | 14:00 | UF dropped to 117 mL/h. | |
| 2 | 14:45 | 7.2* | *Level measured from the dialysis catheter during HD. |
| 15:46 | Fomepizole 1500 mg IV. | ||
| 2 | 15:50 | Treatment #2 completed. | |
| 2 | 22:36 | 15 | |
| 3 | 0:50 | Treatment #3 started. Gambro Phoenix™ machine, Revaclear dialyzer, Qb 350 mL/min, Qd 700 mL/min, UF 100 mL/h. | |
| 3 | 4:10 | Circuit clotted; treatment stopped. | |
| 3 | 5:35 | Treatment #3 restarted. Qb 350 mL/min, Qd 700 mL/min, UF 200 mL/h. | |
| 3 | 6:35 | Treatment #3 completed. | |
| 3 | 8:54 | 3.4 | |
| 3 | 10:25 | 3.1 | |
| 3 | 12:42 | 2.2 | |
| 4 | 4:00 | ND |
ED, emergency department; HD, hemodialysis; IJ, internal jugular; KOA, product of the mass transfer coefficient and dialyzer membrane surface area; ND, not detected; Qb, blood flow rate; Qd, dialysate flow rate; UF, ultrafiltration rate. To convert methanol levels from mmol/L to mg/dL, multiply by 3.2. †Note that, though used in this case, the most recent EXTRIP guideline recommends avoiding systemic anticoagulation with hemodialysis due to reports of intracranial hemorrhage occurring in a substantial minority of patients with methanol poisoning [4, 23]