Methanol Poisoning Without Typical Diagnostic Clues or Standard Antidotes: A Case Report on Clinical Decision-Making

Methanol poisoning is a potentially life-threatening condition characterized by severe metabolic acidosis and visual disturbances. Early diagnosis may be challenging due to nonspecific symptoms and limited access to diagnostic tools or antidotes in some settings. We report the case of a 43-year-old woman who ingested a large volume of methanol along with flunitrazepam. On presentation, she showed no signs of metabolic acidosis or visual impairment, and her anion gap remained within the normal range. Laboratory confirmation of methanol exposure was unavailable at the time. Despite the absence of typical diagnostic markers, empirical treatment with continuous renal replacement therapy and enteral ethanol infusion was initiated based on clinical suspicion. A retrospective analysis of a urine sample later revealed a markedly elevated methanol concentration. This case underscores the importance of early clinical decision-making and demonstrates that successful intervention is possible even in resource-limited environments without access to standard diagnostic or therapeutic modalities.