Methanol Intoxication: Differential Diagnosis from Anion Gap-increased Acidosis

Fujita, Motoki; Tsuruta, Ryosuke; Wakatsuki, Jun; Takeuchi, Hitoshi; Oda, Yasutaka; Kawamura, Y.; Yamashita, Susumu; Kasaoka, Shunji; Okabayashi, Kiyoshi; Maekawa, Taira

doi:10.2169/internalmedicine.43.750

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…Serum methanol levels and arterial blood gas are crucial for diagnosis. Moreover, the anion gap and osmolal gap calculations are essential to differentiate between methanol toxicity and other causes of high anion gap metabolic acidosis such as ketoacidosis and lactic acidosis [9,10].…”

Section: Discussionmentioning

confidence: 99%

Methanol, Paracetamol Toxicities and Acute Blindness

Althwanay¹,

Alharthi²,

Aljumaan³

et al. 2020

Cureus

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Methanol toxicity remains a common problem in developing countries including Saudi Arabia. However, it is much less available than other toxins; thus, clinical suspicion and correlation play pivotal roles in diagnosis. On the other hand, paracetamol is widely available and overdose/toxicity is highly suspected especially in young females. Diagnosis of methanol toxicity can be difficult in cases where history is not readily available and it requires a high degree of suspicion, especially when ingestion of another substance is revealed first as should not preclude the possibility of co-ingestion.We report a case of a medically free 26 year old woman who was brought to the Emergency Department (ED) of our hospital with a history of ingestion of a massive amount of paracetamol tablets and a concurrent abdominal pain with vomiting. After arrival, she became unresponsive with Glasgow Coma score (GCS) of 8/15 and was mechanically ventilated. Initial laboratory investigations identify the paracetamol level of 1200 ug/ml and a significantly high anion gap metabolic acidosis. Owing to the suspicious circumstances and the depth of acidosis, a coingestion of methanol and ethylene glycol was suspected. Upon further evaluation, osmolal gap was found to be significantly high as well. Since neither volatile compound screening nor Fomepizole were available in our hospital, an urgent N-acetylcysteine and sodium bicarbonate (NaHCO 3 ) were started alongside hemodialysis. Subsequent brain computed tomography (CT) and magnetic reasoning imaging (MRI) revealed changes in putamen and basal ganglia most consistent with methanol toxicity. She was successively extubated on day four of hospitalization with residual visual deficits that had resolved eventually after several followups.

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Section: Discussionmentioning

confidence: 99%

Methanol, Paracetamol Toxicities and Acute Blindness

Althwanay¹,

Alharthi²,

Aljumaan³

et al. 2020

Cureus

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“…Diagnostiko diferentziala egiteko azidosi metabolikoa eta anion gap balio altua duten egoera guztiak hartu behar dira kontuan (etilenglikol-intoxikazioa, salizitato-intoxikazioa, zetoazidosi alkoholikoa, etab.) (13,14).…”

Section: Jatorrizko Artikuluaunclassified

Metanol-intoxikazioa: diagnostiko kliniko, analitiko eta tratamendu azkarren beharra

Iriarte¹,

Barba²,

Eguiguren³

et al. 2021

Osag

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Metanol-intoxikazioa morbilitate handia duen egoera da, nahasmendu metaboliko larriak, itsutasuna eta disfuntzio neurologiko garrantzitsuak eragin ditzakeena. Hori dela eta, diagnostikoa eta tratamendua garaiz ezarri behar dira. Azkenaldian, metanol-intoxikazio kasuen hazkundea antzeman dugu gure ingurunean (% 50 azken urtean) eta gure ospitalean, gehientsuenetan bezala, ez dago metanola neurtzeko analisi-teknikarik eskuragarri.Horregatik, artikulu honetan ospitalean berriki izan diren lau kasu kliniko aurkezten ditugu, gaixo hauen maneiuari eta datu kliniko eta analitikoei dagokien informazio garrantzitsuena aztertuz. Gure helburua zera da: batzuetan zehazten zaila den diagnostiko goiztiarra ezartzeko estrategia baliagarria garatzea.Intoxikazio mota honen hilkortasun-tasa handia izanik eta tratamendua badagoela jakinik, metanol-intoxikazioa berehala identifikatzea garrantzitsua da. Azaldutako kasu klinikoak aztertu ondoren, emaitzek adierazi zuten susmo kliniko handia, azidosi metabolikoa eta anion gap eta osmol gap altuak diagnostiko goiztiarra egitea ahalbidetzen duten ezaugarriak direla.

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“…Because of the availability of advanced neuroimaging, both in computed tomography and magnetic resonance protocols, putaminal necrosis with varying degrees of haemorrhage tends to be detected much earlier in current practice than it was in the past. However, initial scans may appear unremarkable and days may elapse before lesions are visualised 20,21 .…”

Section: Time Course and Initial Manifestationsmentioning

confidence: 99%

A review of methanol poisoning: a crisis beyond ocular toxicology

Pressman¹,

Clemens

Sahu

et al. 2020

Cutaneous and Ocular Toxicology

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At first blush, methanol poisoning may be seen as an arcane problem generally associated with rapid ocular neuropathy. The emerging clinical reality is that methanol poisoning around the globe has claimed increasingly large numbers of deaths largely due to the press of poverty and the delay in suspecting and diagnosing methanol toxicity. With the onset of the COVID-19 pandemic, false beliefs about methanol's preventive potential vs viral infection of have arisen. In March of this year, more than 300 Iranians died and 1000 became ill after consuming methanol in the hope that it would protect them against the novel coronavirus. We review the context and magnitude of methanol toxicity, pathophysiology, principal medical issues, and human variability in metabolism. While toxicologists and clinicians may need to be especially attentive to this problem, it is becoming clear that the social and economic underpinnings of the methanol poisoning crisis must be actively and urgently explored and managed as vigorously as its toxicologic and pathophysiologic components. ARTICLE HISTORY

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Methanol Intoxication: Differential Diagnosis from Anion Gap-increased Acidosis

Cited by 11 publications

References 9 publications

Methanol, Paracetamol Toxicities and Acute Blindness

Methanol, Paracetamol Toxicities and Acute Blindness

Metanol-intoxikazioa: diagnostiko kliniko, analitiko eta tratamendu azkarren beharra

A review of methanol poisoning: a crisis beyond ocular toxicology

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