Formic and lactic acidosis in a fatal case of methanol intoxication

A 33-year-old white man was admitted to the University of Utah Hospital after about 30 h of various symptoms, including blurred vision and (eventually) severe left flank and back pain. Upon admission, his serum pH was 6.80 and serum bicarbonate concentration (calculated from pCO2 and pH) was 3.9 mmol/L. The etiology for the acidosis became apparent 10 h after admission, when assay of the serum prepared from a blood specimen obtained at admission revealed a methanol concentration of 74 mmol/L (2.4 g/L). At this time the patient was placed on hemodialysis and intravenously infused with sodium bicarbonate. The methanol concentration in serum had decreased to 21 mmol/L 2 h later. Formate and lactate concentrations were, respectively, 10 and 23 mmol/L in serum sampled 4.5 h after hospitalization, at which time serum pH was 6.91 and bicarbonate concentration 7 mmol/L. The patient eventually died with extensive neuropathy.