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Table 2 Treatment events including hemodialysis prescription

From: Severe methanol poisoning treated with a novel hemodialysis system: a case report, analysis, and review

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

 
  1. 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]