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(New Zealand Herald)   Man blinded by vodka regains eyesight by drinking whiskey   (nzherald.co.nz) divider line 15
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7025 clicks; posted to Main » on 01 Dec 2012 at 11:10 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-12-01 09:42:11 AM
10 votes:

CPT Ethanolic: Gonna have to call bullshiate on this story. Diabetes does not respond differently to liquor. But your mom does.

/boom.


No, the article writer just sucks ass at writing an article.

He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan
2012-12-01 11:28:56 AM
3 votes:

willfullyobscure: Acupuncture and chiropractic work GREAT for chronic pain and won't land you in the poor house. So get off your high horse, Mr. Middle Class


upload.wikimedia.org

The evidence for accupuncture is sketchy at best, and the field is massively overrun with woo about energy fields rather than targeting an obvious biological basis for why it works in some people - the release of endorphins, enkephalons, and endocannabanoids.

Nothing a chiropractor does is any different than what a Physical Therapist would do, for cheaper, and using scientific basis for doing so. Chiropractic "medicine" is based on a late 19th century belief that spinal injury and "subluxations" of the vertebra are responsible for all disease in the human body.
2012-12-01 05:36:26 PM
1 votes:

ExcaliburPrime111:
By using the Henderson-Hasslebach equation, you can figure out what ratio of protonated to unprotonated formic acid there is.

pH = pKa + log ([A-]/[HA]), where pH is the person's pH, pKa is the pKa of the chemical, [A-] is the concentration of the deprotonated form, and [HA] is the concentration of the protonated form.

So, for someone with a pH of 7.4 (normal) and formic acid's pKa of 3.7, you would get a ratio of [A-] to [HA] of 5000:1 (i.e. mostly deprotonated form.)

But if you drop the pH to say, 6.8, which is entirely plausible for this patient (it might be even lower) then the ratio changes to about 1250:1. There's still almost all of the formic acid in the deprotonated form, BUT, the concentration of the protonated form is now quadruple what it was. You only need a tiny bit to be absorbed into sensitive end-organs to get severe damage


At pH 6.8 the protonated form is .0792% of total.
At pH 7.4 the protonated form is .0199% of total.

If I think of it in a gen chemistry class way, both those numbers are so small there is little real difference. But if i think about it in a physiologic way, one number is quadruple the other and would have a huge impact on cell functioning. So that makes sense I guess.

Thanks for breaking it down for me.
2012-12-01 05:07:04 PM
1 votes:

BigLuca: ExcaliburPrime111: BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.

And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

The way this works is formate (which is the same thing as "formic acid") and glyoxylate exist as charged species at the normal pH of most people (which is about 7.4). Those charged species have a COO-

If the person who has formate or glyoxylate is also acidemic (their pH is much lower than 7.4), then those charged species get protonated (i.e. COO- picks up a proton, and it become COOH.) This is bad because when the metabolites were negatively charged, they will have a very tough time penetrating end-organ tissues, whereas if they are neutral, then they are much more hydrophobic, and much more able to penetrate end-organ tissues.

Summary: Neutral things are more hydrophobic than charged things and can be absorbed better into end-organ tissues. Acidemia causes protonation of negatively charged acid metabolites, which then become neutral. To treat someone who has both ingested formate (or glyoxylate) AND has acidemia, you should treat with sodium bicarbonate, which will raise the pH, w ...


By using the Henderson-Hasslebach equation, you can figure out what ratio of protonated to unprotonated formic acid there is.

pH = pKa + log ([A-]/[HA]), where pH is the person's pH, pKa is the pKa of the chemical, [A-] is the concentration of the deprotonated form, and [HA] is the concentration of the protonated form.

So, for someone with a pH of 7.4 (normal) and formic acid's pKa of 3.7, you would get a ratio of [A-] to [HA] of 5000:1 (i.e. mostly deprotonated form.)

But if you drop the pH to say, 6.8, which is entirely plausible for this patient (it might be even lower) then the ratio changes to about 1250:1. There's still almost all of the formic acid in the deprotonated form, BUT, the concentration of the protonated form is now quadruple what it was. You only need a tiny bit to be absorbed into sensitive end-organs to get severe damage.
2012-12-01 03:50:35 PM
1 votes:

The One True TheDavid: Hey BM, I'd love it if you translate what you learn into English for dullards like me. I could write a bood on the Christological controversies of the 4th century church, but science, like math, is HARD.


Sorry, I tend to talk technical without realizing it. I'm like that in real life, but much quieter. I have to catch myself.

So, you have this enzyme. It's called Alcohol Dehydrogenase. It breaks down alcohols like methanol and ethanol into simpler chemicals so it can be either used or eliminated from the body, and prevents it from being toxic to your cells.

So, think of Alcohol Dehydrogenase as a horny guy at a bar.

So, let's say the first thing he sees a methanol. We'll make her the fat chick. He's not having any other luck tonight, and he's desperate. So he's going to get with Methanol, and have a little fun at the end of the night. Unfortunately for Alcohol Dehydrogenase, he leaves a mess in the morning. Formaldehyde. So this second enzyme, Aldehyde Dehydrogenase - it acts as the housekeeping in the morning. It picks up the Formaldehyde, and while meaning to do good, turns it into Formic Acid. Formic acid then attacks your retinas and optic nerves, and leads to blindness. It also massively farks with your kidney function.

But, let's reverse the scenario. Say right behind methanol, ethanol walks in. Ethanol is smokin' hot, and has all of Alcohol Dehydrogenase's fetishes. He's going to go with Ethanol over Methanol. Methanol's going home alone. Methanol alone, without being metabolized, is not very toxic - the kidneys pull it out, and it gets excreted in the urine. That's why they used to give these people IV or PO ethanol to maintain their BAC at 0.1 or Above.

Now, we use Fomepizole. It cockblocks Alcohol Dehydrogenase.

BigLuca: Yep, get all that. What we were discussing was the formic acid pKa of 3.7. From what I remember of pKa's, above 3.7 you will have almost totally formate, and it converts almost totally formic acid at 3.7. And this is not a proportional thing, it's pretty sudden (within 1 pH or so). So at pH 7.4 (normal pH) you will have about the same ratio of formic acid to formate as at pH 6.0 (pretty damn acidic). I've never hear of anyone's blood pH being lower than 6.0. Maybe the tiny increase in formic acid you get from a pH of 7.4 to a pH of 6 is physiologically significant? I don't know, I forgot how to figure that out, I just remember it is not much of a change at all.


The lowest PH I've seen in a live patient is 6.7, and that was in a massive new onset Diabetic Ketoacidosis. I've seen 6.2, but that was a blood gas taken inguinal after we had been working the kid for fifty minutes during cardiac arrest.
2012-12-01 02:42:10 PM
1 votes:

BigLuca: ChubbyTiger:

Found this on Uptodate

Methanol is metabolized to formate, and ethylene glycol to glycolate, glyoxylate, and oxalate. Acidemia leads to protonation of these species to uncharged molecules (eg, formic acid), making them more likely to penetrate end-organ tissues (such as the retina) and more likely to be reabsorbed across the renal epithelium from the urine. Thus, patients with methanol or ethylene glycol poisoning fare worse when systemic acidemia is present [10]. Treatment with sodium bicarbonate leads to deprotonation of these acid species, making them less likely to penetrate end-organ tissues and more likely to be excreted in the urine.

But I give up, it's over my head. The reference isn't publicly available and my school doesn't have access either, so I can't really say why that is.


And... this is why I think requiring med students to take two years of Chemistry is a waste of time, because they're not going to remember it anyway.

The way this works is formate (which is the same thing as "formic acid") and glyoxylate exist as charged species at the normal pH of most people (which is about 7.4). Those charged species have a COO-

If the person who has formate or glyoxylate is also acidemic (their pH is much lower than 7.4), then those charged species get protonated (i.e. COO- picks up a proton, and it become COOH.) This is bad because when the metabolites were negatively charged, they will have a very tough time penetrating end-organ tissues, whereas if they are neutral, then they are much more hydrophobic, and much more able to penetrate end-organ tissues.

Summary: Neutral things are more hydrophobic than charged things and can be absorbed better into end-organ tissues. Acidemia causes protonation of negatively charged acid metabolites, which then become neutral. To treat someone who has both ingested formate (or glyoxylate) AND has acidemia, you should treat with sodium bicarbonate, which will raise the pH, which will deprotonate the acidic species. You should also take the usual steps to treat the methanol or anti-freeze ingestion.
2012-12-01 12:34:59 PM
1 votes:

BronyMedic: CPT Ethanolic: Gonna have to call bullshiate on this story. Diabetes does not respond differently to liquor. But your mom does.

/boom.

No, the article writer just sucks ass at writing an article.

He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan


You are forgetting about the acidosis angle. Metabolic and/or alcoholic ketoacidosis can cause blindness all by itself -- Nonarteritic Anterior Ischemic Optic Neuropathy or plain AION. They fact that the article mentions diabetes and the doctor smelled "nail polish remover" strongly suggests there was a ketoacidoitic process going on. Acidosis can worsen any methanol poisoning he had by promoting formic acid formation over formate and increase tissue penetration. The ischemic neuropathy can be treated long into the course of the blindness by administering steroids and correcting the acid imbalance. Optic damage from acute methanol poisoning tends to be more permanent over a shorter time period.

In reality, I bet it was a combination of the two. The fact that they didn't use fomepizole and had to go out and buy whisky is weird though.

Just thought of another thing. The interaction he had with this DM-II medication could be Metformin which has a serious ADR of lactic acidosis, I would imagine that could promote the formation of formic acid like any other acidosis.
2012-12-01 12:04:43 PM
1 votes:
Johnny Walker Black? B'ah! Just kill me already rather than feeding me that crap!

www.lcbo.com

\not too late to change this into a whisky (not whiskey!) snob thread!
2012-12-01 11:51:30 AM
1 votes:
Well, as a long time home brewer and microbiologist/biochemist, I can tell you that there is no way in the wide world that methanol will ever be present in any commercial brand of alcohol. Also I can tell you that if the alcohol in the vodak reacted with this fellow's meds, so would the alcohol in the whisky.

I have had many many glasses of homemade beer and wine, and gallons of prairie shine, and guess what? Nary a problem, nor with anyone I know. The only time I was associated with methanol poisoning was when, as an army medical assistant, seven soldiers came into the MIR having had a punch with gasline antifreeze as one of the components. And yes, we administered brandy. One died, two were blinded and the others walked away from it.

\yup
\\likely attempted murder.
2012-12-01 11:48:16 AM
1 votes:

spawn73: Why could they wait so long before administring ethanol? Why doesn't a hospital have ethanol, how do they clean?


Well, to be quite honest, no one really uses ethanol anymore unless they have to. No one cleans with ethanol anymore, it's all solutions that are Quaternary Ammoniums, Bleech-based compounds, or other harsh chemicals designed to be tuberculocidal. Even then, it's given IV, not PO, usually.Fomepizole is the drug that's more commonly stocked and used, and is more predictable than targeting a BAC of 0.1 - 0.15 (IIRC, it's been a LONG time since I've gone over ethanol drips.) Who knows. Their stock may have been expired, or they might not have even had it in the formulary.

siyuntz: Huh. I always thought alcohol dehydrogenase turned methanol into formaldehyde, which was then converted to formic acid by another enzyme, aldehyde dehydrogenase. I think you skipped an intermediate step there, BronyMedic.


Yes I did. Thank you for correcting me.
2012-12-01 11:38:19 AM
1 votes:
Huh. I always thought alcohol dehydrogenase turned methanol into formaldehyde, which was then converted to formic acid by another enzyme, aldehyde dehydrogenase. I think you skipped an intermediate step there, BronyMedic.
2012-12-01 11:30:34 AM
1 votes:

BronyMedic: CPT Ethanolic: Gonna have to call bullshiate on this story. Diabetes does not respond differently to liquor. But your mom does.

/boom.

No, the article writer just sucks ass at writing an article.

He got a hold of some tainted vodka, and drank methanol. Methanol is metabolized by alcohol dehydrogenase into formaldehyde, which is further metabolized into formic acid. Formic Acid LOVES your optic nerve. It likes to fark it like Lindsey Lohan in a free wet bar hotel. Ethanol competitively inhibits Methanol metabolism by having a higher affinity for ADH than it. So you pee the methanol out rather than turn it into Lindsey Lohan


Dude. I'm rolling here... :D

The next time I run my still I'm going to "Drain the Lohan" instead of dumping the heads.
2012-12-01 11:29:12 AM
1 votes:
So, he had rye surgery?
2012-12-01 11:16:43 AM
1 votes:

Slartibeerfest: Thumbs up for alternative medicine.


atheistetiquette.files.wordpress.com

Tell me. Dear Storm. Do you perhaps know what we call alternative medicine that works?

Medicine.
2012-12-01 10:51:32 AM
1 votes:
Alcohol: The cause of, and solution to, all life's problems.
 
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