Methanol Poisoning

Obtunded

Step 1: View clinicals

A 6 year old girl presents with diffuse abdominal pain, profuse vomiting, blurred vision, agitation, a generalized headache, and worsening dyspnea for 4 hours. She also started wheezing 30 minutes ago. Her medical and surgical histories are unremarkable, and there is no family history of bronchial asthma. Her growth and development are age appropriate. Her random plasma glucose is 110 mg/dL, while a complete blood count is within normal parameters.


Step 2: Order all relevant investigations

Arterial Blood Gases + Electrolytes

FiO2: 45% pH: 6.9 (7.34-7.44) PaO2: 108 mmHg (75-100) PaCO2: 26 mmHg (35-45) HCO3-: 3 mEq/L (22-26) Anion Gap: 23 mEq/L (<16) Na+: 133 mEq/L (135-145) K+: 5.5 mEq/L (3.5-5.5) Cl-: 105 mEq/L (97-105)

Serum Lactate

Serum Lactate: 0.6 mmol/l (0.5 - 2.2)

Liver Profile + Renal Function Tests

AST: 4490 IU/L (7-55) ALT: 8030 IU/L (8-48) ALP: 110 IU/L (45-115) Albumin: 4.5 g/dL (3.5-5) Total Protein: 7.0 g/dL (6.3-7.9) Bilirubin: 0.3 mg/dL (0.1-1.0) INR: 1 (0.9-1.1) Blood Urea: 37 mg/dL Serum Creatinine: 0.4 mg/dL

Toxicology Screen

Acetaminophen: undetectable Salicylates: undetectable Ethyl Alcohol: undetectable Methanol: 67 mg/dL Ethylene Glycol: undetectable Isopropyl Alcohol: undetectable


Step 3: Select appropriate management

Urgent Hemodialysis
Fomepizole
IV Sodium Bicarbonate
Insulin


Score: ★★☆