Severe Methanol Poisoning with Supralethal Serum Formate Concentration: A Case Report.

Abstract

OBJECTIVE:

To present a case of survival without visual and central nervous system sequelae at a formate concentration of twice the reported lethal level.

CLINICAL PRESENTATION AND INTERVENTION:

This was a case of a 33-year-old man who ingested 1 liter of a toxic mixture of methanol and ethanol. Upon admission, he presented with anxiety, tachycardia and hypertension and had a serum formate level of 1,400 mg/l (normal range 0.9-2.1 mg/l), a methanol level of 806 mg/l (normal range 2-30 mg/l), an undetectable ethanol concentration and a normal lactate level. A 10% solution of ethanol and folinic acid was administered intravenously and two 8-hour sessions of intermittent hemodialysis were performed. The patient was discharged on the fifth day without sequelae of poisoning. The follow-up examinations 3 months and 2 years later revealed no damage to the basal ganglia. The patient had normal visual-evoked potential and findings on optical coherence tomography. The genetic analysis revealed a rare minor allele for the gene coding CYP2E1 enzyme of the microsomal ethanol oxidizing system.

CONCLUSION:

The patient survived acute methanol poisoning without long-term sequelae despite a high serum level of formic acid upon admission.

• Authors: Olga Nurieva, Katerina Kotikova
• Journal: Medical principles and practice : international journal of the Kuwait University, Health Science Centre (Med Princ Pract) Vol. 24 Issue 6 Pg. 581-3 ( 2015) ISSN: 1423-0151 [Electronic] Switzerland
• PMID: 26380973 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 S. Karger AG, Basel.

Chemical References

• Formates
• formic acid
• Ethanol
• Leucovorin
• Methanol

Topics

• Adult
• Ethanol (poisoning)
• Formates (blood)
• Humans
• Leucovorin (administration & dosage)
• Male
• Methanol (poisoning)
• Poisoning (therapy)
• Renal Dialysis