Methanol toxicity from inhalational abuse of a methyl acetate-containing nail polish remover

Methyl acetate is an organic solvent used in certain nail polish removers that hydrolyzes in aqueous environments to liberate methanol and acetic acid. This is a case report of a 47-year-old woman who presented to the emergency department intoxicated after an episode of loss of consciousness following recreational huffing of a nail polish remover containing methyl acetate. Laboratory studies demonstrated an elevated anion-gap metabolic acidosis suggestive of methanol toxicity. Diagnosis was confirmed through measurement of the serum methanol concentration, which was 35 mg/dL (reference range < 10 mg/dL). Toxicity was managed in the emergency department with administration of fomepizole (4-methylpyrazole) and initiation of hemodialysis. After a single session of hemodialysis, the patient's acid-base status normalized, visual changes resolved, and mental status returned to baseline. The patient was subsequently discharged on hospital day 2. This is an uncommon case of acute systemic methanol poisoning from inhalation of methyl acetate resulting in profound acidemia requiring hemodialysis. This case underscores the importance of careful product review and ingredient identification in the emergency department.