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    Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19

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    Author
    Holzman, Sarah Denise
    Larsen, Jaiva
    Kaur, Ramandeep
    Smelski, Geoffrey
    Dudley, Steven
    Shirazi, Farshad Mazda
    Affiliation
    Arizona Poison and Drug Information Center, University of Arizona College of Pharmacy
    Department of Emergency Medicine, University of Arizona College of Medicine
    Department of Medical Pharmacology, University of Arizona College of Medicine
    Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy
    Issue Date
    2021-03-23
    Keywords
    alcohol-based hand sanitizer
    case series
    COVID-19
    methanol poisoning
    mortality
    
    Metadata
    Show full item record
    Publisher
    Taylor and Francis Ltd.
    Citation
    Holzman, S. D., Larsen, J., Kaur, R., Smelski, G., Dudley, S., & Shirazi, F. M. (2021). Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19. Clinical toxicology, 1-6.
    Journal
    Clinical Toxicology
    Rights
    © 2021 Informa UK Limited, trading as Taylor & Francis Group.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Background: The advent of COVID-19 increased attention to hand hygiene in prevention of disease transmission. To meet the increased demand for hand sanitizer during the pandemic, the US FDA issued an Emergency Use Authorization allowing new manufacturers and importers to enter the market. Some of the newly introduced hand sanitizer products contained methanol in lieu of ethanol or isopropanol. We describe five patients with fatal methanol poisoning resulting from hand sanitizers improperly containing methanol. Case summary: Comparing a 5-month period from 2019 to the same time frame in 2020, the Arizona Poison and Drug Information Center has seen an increase of 124% in exposures to hand sanitizer. Of these cases, 28% involved methanol-contaminated hand sanitizer. Five of these patients died from methanol poisoning. All five cases had similar clinical features with severe high anion gap metabolic acidosis and, in four patients, elevated osmolal gap. Methanol concentrations were consistently very elevated, but these results were not available before the patients succumbed. Four of the patients received fomepizole and adjunctive care. Two patients received emergency extracorporeal therapy. All five died despite maximal treatment efforts. Conclusion: During the pandemic in 2020, there was a proliferation of alcohol-based hand sanitizers which contained methanol. Exposure to these products, which failed to meet regulatory standards, led to increased harm and death. Challenges to treatment of methanol poisoning, especially in rural areas, include lack of access to timely laboratory measurement of methanol concentrations and lack of available emergency hemodialysis without transfer of the patient. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
    Note
    No embargo COVID-19
    ISSN
    1556-3650
    EISSN
    1556-9519
    DOI
    10.1080/15563650.2021.1895202
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1080/15563650.2021.1895202
    Scopus Count
    Collections
    UA Faculty Publications

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