Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19
AuthorHolzman, Sarah Denise
Shirazi, Farshad Mazda
AffiliationArizona 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
MetadataShow full item record
PublisherTaylor and Francis Ltd.
CitationHolzman, 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.
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AbstractBackground: 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.
NoteNo embargo COVID-19
VersionFinal accepted manuscript