Supervisors: professor Joel Starkopf (TÜ anestesioloogia ja intensiivravi kliinik), professor Aleksandr Žarkovski (TÜ bio- ja siirdemeditsiini instituut), professor Dag Jacobsen (Oslo Ülikool), dr Knut Erik Hovda (Oslo Ülikooli haigla)
Opponent: dotsent Kaarlo Hoppu, MD, PhD (Helsingi Ülikool, Soome)
Methanol is a highly toxic alcohol killing hundreds or even thousands of people every year worldwide. Even in Estonia, more than ten patients are on average hospitalised every year. During nine days in September 2001, a large outbreak of methanol poisonings occurred in the Western part of Estonia: A total of 154 patients were admitted to the local hospital, challenging not only the local resources, but the whole Health care system in Estonia as such. In parallel to treating all these patients, a systematic collection of data was initiated to evaluate the patients, the treatment that were given, and their outcome. Half of the admitted patients were discharged from hospital in a healthy condition, whereas 23% of the hospitalized patients died. In addition to those victims, many patients were found dead outside hospital without ever making it to any medical support. We searched for the survivors from the outbreak six years later, and found that all patients discharged with either visual or neurological impairment still suffered from this. The Estonian data were merged with similar data from methanol outbreaks in Norway, Iran and Tunisia, to look for relevant markers that can predict the patients' outcome already when they are admitted to hospital. We found that being unconscious on admission to hospital was associated with a bad prognosis, as well as being very acidic in their blood. Finally, we found that the patients that were able to breath very fast to compensate for their acidic blood had a better prognosis than the ones that were not able to. International database gives us opportunity to evaluate the effectiveness of the to alternative antidotes on the market: fomepizole (the new antidote) and ethanol/regular alcohol (the old antidote) In spite of this study having the largest number of patients ever presented, the number was still too small to show any definite difference in outcome. However, fomepizole appeared to have various advantaged over ethanol, and it is clearly superior in simplicity and safety of the treatment. Methanol poisonings is a relatively infrequent condition, making collection of data to gain knowledge a difficult task. This thesis shows the importance of international collaboration between specialists to improve the chances for survival of these patients.