Rrefractory Metabolic Acidosis in a Diabetic Patient : A case of Unsuspected Methanol Intoxication

Abstract

We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital with a history ofrestlessness, blurring of vision and breathlessness for one day. Inspite of conservative treatment for 10 hours, hisgeneral condition gradually detoriated and he was shifted to ICU. He was kept on mechanical ventilator. Hislaboratory results showed severe high anion gap metabolic acidosis not corrected by sodibicarb and adequate fluidresuscitation. MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. His acidosis persistedand after giving 3 sessions of Sustained Low Efficiency Dialysis (SLED), metabolic acidosis was corrected withnormalization of renal function. After six months in a follow-up, patient complained of total blindness and fundalphotography showed bilateral optic atrophy.
 Bangladesh Crit Care J September 2019; 7(2): 111-112

Case Reports Study on Methanol Poisoning in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia

“…To treat and correct severe metabolic acidosis, all six patients were given sodium bicarbonates to reverse acidosis, which may also have had a good impact on the conversion of formic acid to formate and the removal of formate, in agreement with other previous studies [ 26 , 29 , 35 , 38 , 40 ]. Inotropic support including noradrenaline, dopamine, and potassium chloride, in addition to mechanical ventilation, were given to the patients who died, trying to overcome circulatory collapse and pulmonary cardiac arrest, but unfortunately, they failed and the patients died from pulmonary cardiac arrest in addition to anorexic brain damage in patient 1 [ 41 , 42 , 43 ]. Thiamine was used in patients 3, 4, 5, and 6 but we criticize its role as it has very little beneficial effect on methanol poisoning.…”