Accidental methanol ingestion: Case report

The patient presented with hemodynamic instability and severe metabolic acidosis with pH 6.69. The anion gap was 39 mmol/L and the osmol gap 73 mosmol/kg. Treatment with ethanol and continuous venovenous hemodiafiltration (CVVH-DF) was initiated. Despite the hemodynamic instability it is was possible to achieve rapid correction of pH and methanol concentration with CVVH-DF while maintaining a stable and therapeutic ethanol serum concentration. Despite hemodynamic and acid-base improvement, our patient developed massive cerebral edema leading to brain death. Permission for organ donation was unfortunately not ascertained.We conclude that in a hemodynamic instable situation high methanol concentrations and methanol-induced derangements of homeostasis are safely and effectively treated with CVVH-DF and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area.The nature and incidence of alcohol intoxications are race, sex, culture and geographical localization dependent in a lot of cases [1-3]. Since methanol is not readily available and since there's no culture of distilling alcohol at home, severe methanol intoxications are extremely rare in the Netherlands. A foreign sailor visiting the Netherlands accidentally caused himself severe methanol intoxication by drinking unregistered illegally bought industrial alcohol. The background of the patient combined with the particular chemical derangements was indicative of potential methanol intoxication [4,5].Hemodialysis in combination with ethanol or fomipezole, a costly but powerful alcohol dehydrogenase (ADH) blocker is the first choice treatment in case of a severe intoxication [6,7]. Due to severe hemodynamical instability hemodialysis was not an option and fomipezole was not available. Therefore the patient was treated with CVVH-DF and ethanol infusions to block the ADH. In the literature just a few cases using CVVH-DF for the treatment of methanol intoxication