Methanol poisoning in 49-year-old, found unconscious by his brother
Methanol, often known as methyl alcohol, is a flammable, volatile, colourless fluid. Because it is distilled from wood, it is also known as wood alcohol. Methanol is a highly hazardous substance that is often utilised solely for industrial purposes. It is, nevertheless, occasionally utilised as a cheap and illegal counterfeit alternative to ethanol, particularly in nations where ethanol consumption is prohibited. Homemade alcoholic beverages are consumed as less expensive subterranean ethanol alternatives. Recognising methanol poisoning epidemics is frequently difficult due to religious, cultural, and sociological factors, which might impede early detection and efficient treatment.
Limited resources might also contribute to the morbidity and mortality associated with methanol intake. Consuming ethanol and methanol at the same time can have a negative impact on treatment since it can greatly delay symptom presentation and, hence, diagnosis. Reports of methanol poisoning epidemics are sadly common, and these are likely to grow when alcohol intake is restricted for cultural reasons or when alcohol is expensive due to high taxation.
As a result, healthcare personnel should be cautious and suspicious of methanol poisoning patients because morbidity and death are affected by the time between ingestion and commencement of therapy. If methanol poisoning is recognised and treated aggressively before the methanol is metabolised by alcohol dehydrogenase into its deadly metabolite, formic acid, patient outcomes can be improved.
Case report: methanol poisoning
A 49-year-old Saudi man was discovered unconscious by his brother and brought to the emergency. Emergency medical services (EMS) transported him to the emergency department (ED). He had diminished consciousness, hyperventilation, a low-grade temperature, and tachycardia when he arrived. His relatives assumed that his illness was caused by a drug overdose at first. He was intubated and mechanically ventilated because, despite efforts to stimulate and resuscitate him, his Glasgow coma scale (GCS) score remained 9. His initial vital signs were as follows: 136/84 mmHg blood pressure; 145 beats/minute heart rate; 56 breaths/minute respiratory rate; 98% oxygen saturation in room air; and 10 mmol/L glucose level.
Apart from the appearance of bilateral pinpoint pupils, his physical examination was ordinary. He was admitted to the intensive care unit (ICU) after initial stabilisation in the emergency department (ED) due to low GCS and unstable vitals. Because of his hypotension, he was kept on mechanical ventilation and vasopressors. On the second day of his ICU hospitalisation, he began to exhibit indicators of declining mental status, and his computed tomography (CT) scan revealed evidence of cerebral haemorrhage. His stay was worsened by continued evidence of sepsis and end organ damage, as seen by acute renal impairment, deteriorating coagulopathy, rhabdomyolysis, and a positive blood culture screen, as well as transesophageal echocardiography showing infective endocarditis.
Doctors advised antibiotics and vigorous fluid and inotropic support to treat his symptoms. He showed no change in mental status and worsening neurological weakness one week after hospitalisation. His repeated magnetic resonance imaging revealed a new middle cerebral artery infarction, as well as the likelihood of numerous infarctions. Attempts to wean him off of ventilatory support were futile, and tracheostomy insertion was performed. The patient was released with nasogastric and tracheostomy tubes in a stable yet functioning state.
Methanol is metabolised by alcohol dehydrogenase which can cause hazardous consequences
Methanol poisoning is a common occurrence among vulnerable groups. Clandestine alcohol marketing and the existence of local underground networks for selling homemade alcohol result in the availability of cheaply and illegally produced counterfeit impure alcohol containing methanol, which ignorant customers may consume.
Methanol is metabolised by alcohol dehydrogenase into formaldehyde and then to formic acid after consumption, resulting in hazardous consequences. Methanol toxicity has been directly connected to its sluggish metabolism and formic acid buildup. Brent et al. corroborated this by identifying a direct connection between high serum formic acid concentrations and increased morbidity and mortality. In this case, the patient presented after 2 weeks of a social gathering. Moreover, the symptoms developed after 2 days of alcohol consumption.
Source: Journal of Medical Case Reports
