August 27, 2012
A 51-year-old man with chronic alcoholism, admitted with weakness and blurred vision. Subsequent to admission, the patient rapidly deteriorated, developed metabolic acidosis, and went into a coma.
Acute Methanol Intoxication
- Acute methanol intoxication produces severe metabolic acidosis because of conversion of formaldehyde to formic acid.
- Neurologic symptoms include headache, seizures, vision disturbances, and coma.
- Methanol is used as a constituent in a large number of industrial solvents, and, occasionally, it is used for fraudulent adulteration of wine or other spirits.
- Toxicity results from intentional overdose or accidental ingestion.
- Key Diagnostic Features: putaminal necrosis, subcortical white matter edema or necrosis, and optic nerve necrosis
- DDx: Wilson's disease, multiple system atrophy (Parkinsonism type or Shy-Drager type), hypoxic-ischemic encephalopathy, Creutzfeldt-Jakob disease, hyperammonemic encephalopathy
- Rx: supportive therapy, bicarbonate, fomepizole, hemodialysis
