Methanol, Paracetamol Toxicities and Acute Blindness

Abstract

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.

Outcome of Methanol Toxicity Outbreak In Saudi Arabia: Case Series Study

“…Methanol toxicity can present a wide range of symptoms that may overlap with other toxicities or diseases, making it challenging to diagnose, especially in cases where medical history is not immediately available [ 5 ]. Therefore, a high degree of suspicion and early diagnosis is critical to preventing irreversible damage caused by formic acid.…”

“…Methanol toxicity is a global public health problem that affects both industrialized and developing countries. In Saudi Arabia, methanol toxicity cases have been reported in various regions, and methanol toxicity outbreaks have also been reported [ 5 , 6 ]. Therefore, the objective of this case series article is to report on cases of methanol toxicity encountered in our hospital and to highlight the clinical presentation, management, and outcomes of patients with methanol poisoning.…”

Can’t find the antidote: A root cause analysis

“…A literature search of methanol toxicity cases in Saudi Arabia (SA) revealed only four cases ( Algahtani et al, 2018 ; Althwanay et al, 2020 ; Owolabi et al, 2020 ). However, Galvez-Ruiz et al described outcomes of optic disk cupping following methanol poisoning in a series of 50 cases presenting at two large hospitals in Riyadh between 2008 and 2014, possibly indicating a higher incidence of methanol toxicity than perceived ( Galvez-Ruiz et al, 2015 ).…”