Inhalational and percutaneous methanol toxicity in two firefighters

We present two cases of adult inhalational and percutaneous methanol toxicity resulting from transient exposure to vaporized methanol. Both patients complained only of a mild headache at the time of the emergency department evaluation and had normal physical examinations, normal anion gaps, and peak methanol levels of 23 and 16 mg/dL, respectively. Emergency physicians should recognize the potential for toxic transcutaneous absorption of methanol. Because of the varying relationship between clinical symptoms, physical examination findings, and anion gap values to potentially toxic methanol exposures, acquisition of empiric serum methanol levels appears warranted in appropriate situations.