Name of the Procedure:

Injection, fomepizole, 15 mg (J1451)

Summary

Fomepizole injection is a medical procedure where a substance called fomepizole is injected into the patient's bloodstream. It is often used in cases of toxic alcohol poisoning, such as methanol or ethylene glycol poisoning, to help prevent the body from converting these toxic substances into even more harmful compounds.

Purpose

Fomepizole is used to treat patients suffering from toxic alcohol poisoning. The main goal is to stop the toxic substances from being metabolized into more harmful compounds, thereby reducing the risk of severe health issues such as metabolic acidosis, organ failure, and death.

Indications

• Suspected or confirmed methanol poisoning
• Suspected or confirmed ethylene glycol poisoning
• Patients showing symptoms like confusion, unconsciousness, difficulty breathing, or severe metabolic acidosis
• Elevated levels of methanol or ethylene glycol in the blood

Preparation

• No specific fasting required
• Blood tests to confirm the presence of toxic substances
• Baseline assessment of kidney and liver functions
• Inform the healthcare provider about any ongoing medications or allergies

Procedure Description

1. Initial Assessment: The healthcare provider assesses the patient's condition and confirms the need for fomepizole.
2. Intravenous Access: An IV line is established in the patient's vein.
3. Dosage Calculation: The appropriate dosage of fomepizole is calculated based on the patient’s weight and severity of poisoning.
4. Injection: Fomepizole is slowly injected through the IV over a prescribed period, typically 30 minutes.
5. Monitoring: The patient's vital signs and symptoms are closely monitored during and after the injection.

Duration

The injection itself usually takes about 30 minutes. Monitoring and follow-up may extend the overall procedure time to a few hours.

Setting

• Hospital emergency room
• Intensive care unit (ICU)
• Sometimes in a specialized outpatient clinic

Personnel

• Emergency room physician or toxicologist
• Nurses
• Sometimes a pharmacist for dosage consultation

Risks and Complications

• Common: Mild headache, dizziness, nausea
• Rare: Allergic reactions, injection site reactions, transient hypotension
• Management: Symptoms generally manageable with supportive care

Benefits

• Rapid cessation of toxic substance metabolism
• Prevention of severe complications like acidosis, organ damage, or death
• Symptoms of poisoning may start to improve soon after treatment

Recovery

• Continuous monitoring in the hospital for at least 24 hours after the injection
• Possible follow-up injections depending on severity
• Regular blood tests to monitor toxin levels and organ function
• Instructions to avoid exposure to known toxic alcohols

Alternatives

• Ethanol therapy: Competes with toxic alcohols for the same enzyme, but has more side effects and requires intensive monitoring
• Hemodialysis: Directly removes toxins from the blood, but is more invasive and resource-intensive

Patient Experience

• During: The patient may experience minor discomfort at the injection site. Some may feel light-headed or nauseated.
• After: Patients generally feel better as toxin levels decrease. Any pain or discomfort is usually mild and manageable with standard pain relief measures.

Overall, fomepizole injection is a crucial and effective treatment for toxic alcohol poisoning, offering rapid and significant benefits to affected patients.