Can't find the antidote: A root cause analysis.

Background: In a series of cases that came to be recognized as a national methanol outbreak, an incident of delay in allocation and treatment with the antidote fomepizole is described with aim of sharing a learning experience. Method: A team of 16 members was formed to conduct a Root Cause Analysis (RCA), which included multiple individual interviews with the stakeholders and inspection visits to the area. Results: Root causes: The restocking process was unclear and inconsistent and specifically lacked a restocking policy for antidotes, inappropriate labeling and area design, and a sound-alike between fomepizole and omeprazole. Contributing factors included: unsuitable restocking practice and lack of training in using the pharmaceutical electronic inventory system. Corrective actions were recommended and implemented. Conclusion: Management of antidotes in large healthcare systems requires a team effort to ensure appropriate and timely availability in emergency poisoning cases. This RCA identified important areas for improvement that could be insightful to other institutions in preventing similar vulnerabilities and is unique in describing the details of system improvements that can have a large impact on patient safety.

[When a Gap Leads to an Answer]. / Wenn eine Lücke zur Lösung führt.

When a Gap Leads to an Answer Abstract. We report the case of a 22-year-old patient who was found somnolent after previously complaining of nausea, abdominal pain, and vomiting. The main findings were high anion gap metabolic acidosis and lactatemia. Causative was the ingestion of ethylene glycol using a car antifreeze agent with suicidal intent.

[A Sweet Drink with Consequences]. / Ein süsser Drink mit Folgen.

A Sweet Drink with Consequences Abstract. Intoxications with ethylene glycol are rare, however, small quantities from the substance can be life-threatening. Regarding the treatment it is important to recognize the intoxication quickly and to immediately start the appropriate treatment. Intoxications with ethylene glycol or with methanol should always be considered as differential diagnosis in patients with severe metabolic acidosis. It is also very important to calculate the osmolal gap.

Intoxicación por etilenglicol / Intoxication due to ethylene glycol

Resumen La intoxicación por etilenglicol es una urgencia médica y debe ser tratada como tal. El diagnóstico puede efectuarse con la existencia de acidosis metabólica con brecha aniónica amplia, aumento de la osmolaridad sérica, cristaluria de monohidrato de oxalato de calcio y lesión renal aguda. Cursa con tres fases bien definidas, aunque algunos autores consideran una cuarta. Puede prescribirse etanol oral asociado con hemodiálisis en los sitios donde no hay disponibilidad de fomepizol o de etanol para administración parenteral.

Abstract Ethylene glycol poisoning is a medical urgency and must be treated as so. Diagnosis can be achieved by metabolic acidosis with the pres ence of a wide anion gap, increase in serum osmalarity, cristalluria of calcium oxalate monohidrate and acute renal failure. It courses with three defined phases, although some authors identify a fourth phase. Ethanol can be used, associated to hemodyalisis, in the places where there is not availability for fomepizole or ethanol of parenteral administration.

Muerte cerebral secundaria a intoxicación por metanol / Brain death secondary to methanol poisoning

Las intoxicaciones por alcohol metílico son raras, pueden ser secundarias a intentos suicidas, accidentes e incluso a envenenamientos endémicos, tienen consecuencias severas que incluyen la muerte, secundarias a productos de la degradación del alcohol metílico por la alcohol deshidrogenasa, a continuación, presentamos un caso de intoxicación por alcohol metílico que como secuelas presentó alteraciones neurológicas y muerte. (Acta Med Colomb 2012; 37: 211-214).

Methyl alcohol poisoning is rare and may be secondary to suicide attempts, accidents and is also caused by endemic poisonings. It has severe consequences including death secondary to degradation products of methyl alcohol by alcohol dehydrogenase. We present a case of methyl alcohol poisoning that presented neurological alterations and death. (Acta Med Colomb 2012; 37: 211-214).

Intoxicación con etilenglicol. Presentación de casos y revisión de la literatura / Intoxication with ethylene glycol. Presentation of cases and review of literature

El etilénglicol es un producto utilizado en la industria química. La ingesta o aspiración de esta sustancia es una emergencia médica que se debe diagnos� ticar y tratar de inmediato. Inicialmente produce un cuadro conocido como "embriaguez sin aliento alcohólico", seguido de toxicidad cardiopulmonar y renal con grave acidosis metabólica con brecha aniónica aumentada. En la mayoría de los Centros, no es posible determinar la concentración de eti� lénglicol en sangre, por lo que el diagnóstico inicial se basa en la anamnesis y en la presencia de acidosis metabólica grave con brecha aniónica elevada. El tratamiento consiste en soporte vital, adecuada infusión de fluidos y bicar� bonato de sodio, administración de etanol o fomepizol para antagonizar la enzima alcohol deshidrogenasa y, en algunos casos, hemodiálisis.(AU)

The ethylene glycol is a product used in the chemical industry. The intake or inhalation of this substance is a medical emergency that should be diagnosed and treated early. Initially it causes a condition known as "drunkenness with� out alcoholic breath", followed by cardiopulmonary and renal dysfunctions with severe metabolic acidosis and increased anion gap. Determination of blood levels is not available in most health care centers, so initial diagnosis should be based on history and the presence of metabolic acidosis with el� evated anion gap. Treatment consists of vital support, adequate fluid and bicarbonate infusion, administration of ethanol o fomepizole to antagonize the � genase and, in some cases, hemodialysis.(AU)