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Mind the gap: a case of severe methanol intoxication
Salik Nazir1, Stephen Melnick1, Shabana Ansari1
1Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
BMJ Case Reports
|February 27, 2016
Summary
A 37-year-old woman with diabetes experienced severe metabolic acidosis and coma due to methanol intoxication. Prompt treatment with fomepizole and hemodialysis led to recovery, though with lasting cognitive and visual deficits.
Area of Science:
- Toxicology
- Emergency Medicine
- Neurology
Background:
- Diabetes Mellitus (DM) management with sitagliptin.
- Alcohol abuse as a significant comorbidity.
- Unresponsive presentation to the emergency department.
Observation:
- Profound high anion gap metabolic acidosis.
- Significantly increased serum osmolal gap.
- Glasgow Coma Scale score of 3/15 necessitating intubation.
Findings:
- Methanol intoxication confirmed with serum methanol level of 237 mg/dL.
- Brain MRI revealed characteristic changes in the putamen of bilateral basal ganglia.
- Successful extubation on day 2, with residual cognitive and visual deficits.
Implications:
- Highlights the critical importance of considering toxic alcohol ingestions in cases of severe metabolic acidosis.
- Emphasizes the role of early diagnostic evaluation, including osmolal gap and specific toxin levels.
- Underscores the need for prompt intervention with antidotes (fomepizole) and supportive care (hemodialysis) in toxic ingestions.
- Suggests potential long-term neurological sequelae even with appropriate treatment.
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