While in the CT scanner he vomited, had a generalized seizure, and became obtunded. He developed a progressive metabolic acidosis and hyperkalemia. Therapy included sodium bicarbonate, phenytoin, ceftriaxone, lorazepam, and hemodialysis. The patient expired 5 days after presentation. These alcohols are metabolized within the first 12 hours to toxic metabolites that cause a profound metabolic acidosis and multisystem organ failure.
Methanol also causes blindness.
Watch for approval of the new 4-methyl pyrazone antidote, a safer way to inhibit methanol and ethylene glycol metabolism. Patients often need treatment, hemodialysis in this case, before serum levels are reported. A large osmolar gap in a patient with a severe anion gap metabolic acidosis should suggest a toxic alcohol etiology.