Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Toxic alcohol poisoning (methanol or ethylene glycol) can cause severe metabolic disturbances, end-organ damage, and death. Timely diagnosis is paramount and predicated on history, lab markers, and confirmatory laboratory testing, which inform antidote use and/or hemodialysis. Confirmatory toxic alcohol testing capabilities and turnaround times vary by geographic region. Our objective in this study was to evaluate how differences in toxic alcohol testing turnaround times impact our primary outcome of hospital length of stay and secondary outcomes of antidote (fomepizole) administration and medical outcomes (including death, major, moderate, and minor effects) among patients with suspected toxic alcohol poisoning.

Methods: This is a retrospective cohort study of toxic alcohol poisoning cases reported to two U.S. poison centers, Michigan Poison and Drug Information Center (MiPDC) and Florida’s Poison Information Network (FPIN), from 2018–2022. Based on investigator experience with each center’s practice patterns, MiPDC had a toxic alcohol testing turnaround time of 12-24 hours, while FPIN had turnaround times averaging 5-7 days. We queried poison center databases for cases where fomepizole was recommended and/or administered. Medical outcomes were categorized using National Poison Database System definitions: minor effects (minimally bothersome symptoms); moderate effects (pronounced symptoms requiring treatment); major effects (life-threatening or significant disability); and death. We excluded cases if there was no concern for toxic alcohol poisoning or if fomepizole was administered for acetaminophen poisoning. 

Results: A total of 963 cases met inclusion criteria: (MiPDC, n = 590; and FPIN, n = 373). Patients reported to FPIN had a longer median hospital length of stay compared to MiPDC (65.0 versus 48.0 hours, P < .001). FPIN patients received more doses of fomepizole (2.0 versus 1.0 doses, P < .001). FPIN patients had 4.1 times the odds of major effect (95% CI, 1.3-13.3) (P = .02) and 4.7 times the odds of minor effect (95% CI, 1.4-15.8) (P = .01), without significant association for moderate effects or death.

Conclusion: Access to rapid confirmatory toxic alcohol testing was associated with shorter hospital length of stay, reduced antidote use, and improved medical outcomes in suspected toxic alcohol poisonings. Future studies are warranted to comprehensively characterize the variation in region-specific care and inform efforts to standardize confirmatory testing capabilities.