The Case Files: Methanol or Ethanol Poisoning? Correct Diagnosis Influences Treatment

By Hossein Sanaei-Zadeh, MD.   A 23-year-old man presented with agitation and decreased level of consciousness four hours after consuming homemade alcohol. He was brought in by a friend who had also ingested the same alcohol and was completely symptom-free. The patient had a history of seizures controlled by sodium valproate and a ventricular septal defect repaired in childhood.   He was irritable, lethargic (Glasgow coma score: 12), and hypothermic. His pulse rate was 80 bpm, his respiratory rate was 20 bpm, and his blood pressure was 70/40 mm Hg. His pupils were midsized and reactive. Radial pulse was not detected, and carotid pulse was detected with difficulty.   Bedside glucometery was determined to be 180 mg/dL. The patient's electrocardiogram is shown. The patient experienced cardiopulmonary arrest about 10 minutes after hospital presentation. Advanced life support was performed as were passive external and internal rewarming.   The parameters of venous blood gas analysis were pH=7.15, HCO3=14.7, pCO2=43.2, and BE=-11.3. The lab test results were white blood cells, 11.1 × 103 /mm3; hemoglobin, 15.4; platelets, 187000/mm3; CPK, 49; CPK-MB, 29; blood urea nitrogen, 16; creatinine, 1.6; AST, 21 U/L; ALT,22 U/L; Na, 156 meq/L; and K,5.3 meq/L.   He developed pulseless ventricular tachycardia without response to external pacing. Serum ethanol, methanol, formate, and lactate concentrations were not available. Ethanol was administered during the resuscitation via the nas...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research