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Methanol intoxication: differential diagnosis from anion gap-increased acidosis
Motoki Fujita1, Ryosuke Tsuruta, Jun Wakatsuki
1Advanced Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505.
Internal Medicine (Tokyo, Japan)
|October 8, 2004
Summary
Methanol intoxication was initially misdiagnosed as ethylene glycol poisoning, leading to delayed specific treatment. This case highlights the diagnostic challenges and rare neurological complications, such as putaminal lesions, associated with methanol poisoning.
Area of Science:
- Toxicology
- Neurology
- Emergency Medicine
Background:
- Methanol and ethylene glycol are common toxic alcohols causing metabolic acidosis.
- Distinguishing between methanol and ethylene glycol intoxication can be challenging in emergency settings.
Observation:
- A 65-year-old male presented with drowsiness and severe metabolic acidosis, suspected to be toxic alcohol ingestion.
- Initial treatment included ethanol and hemodialysis, common for both methanol and ethylene glycol poisoning.
- The patient developed visual loss and putaminal lesions on brain CT, suggesting methanol toxicity.
Findings:
- Serum methanol levels confirmed methanol intoxication.
- Putaminal lesions are an uncommon finding in methanol poisoning, typically associated with ethylene glycol.
- Delayed diagnosis and treatment of methanol intoxication can lead to severe neurological sequelae.
Implications:
- This case underscores the importance of considering methanol toxicity even with atypical presentations.
- Early and accurate diagnosis of toxic alcohol ingestion is crucial for appropriate management and preventing irreversible complications.
- Neuroimaging findings can aid in differentiating toxic alcohol ingestions when laboratory results are initially pending.