Ethical approval was obtained from the Medical Ethics Committee of the Screening Library Erasmus MC for publication of this report. Methanol (CH3OH) intoxication has been a rare intoxication in the Dutch population over the years [12]. On the other hand, outbreaks of methanol intoxication, caused by illegally produced alcohol, have been reported extensively in some other countries. Due to progressive Inhibitors,research,lifescience,medical open market policy and the increase of free traffic of workers within and outside Europe, the incidence of alcohol intoxications could increase in countries that are not yet familiar with this problem. Severe methanol intoxication is a rare but life-threatening event, even ingestion of a small amount of methanol can be potentially lethal
[13,14]. Prompt action should
therefore be taken when methanol intoxication is suspected, because delay can have deleterious consequences. Awareness of even the rare possibility of methanol ingestion is thus very important Inhibitors,research,lifescience,medical in emergency medicine. The symptoms of methanol intoxication are not very specific except for the visual disturbances and specially the so called “snowstorm vision” [15]. On the other hand, the presence of a high anion gap acidosis combined with a high osmol gap and normal Delta gap should raise Inhibitors,research,lifescience,medical the level of suspicion. The normal delta- or bicarbonate gap in this case ruled out the presence of another, not directly detectable metabolic derangement, beside the already existing methanol-induced acidosis [5]. Though methanol itself is not very poisonous, the degradation products are extremely harmful. Methanol is easily and rapidly absorbed in the digestive tract and even through inhalation and skin absorption[16]. Methanol is transported to the liver where it is rapidly metabolized Inhibitors,research,lifescience,medical by ADH to formaldehyde, which is further converted Inhibitors,research,lifescience,medical into the toxic formic
acid, by formaldehyde dehydrogenase (FDH). Eventually formic acid is converted into CO2 and H2O. Especially this last step is very important, because this is a slow, enzyme depended pathway, which causes accumulation of formic acid in already intoxicated humans. This last step is considered to be folate dependent, therefore administration of folate in formic acid intoxication has been advocated [17]. The first roughly estimated maximum methanol concentration in our patient, calculated Farnesyltransferase with the use of serum osmolality in the presumed absence of ethanol was 2.5 g/L. The lower limit for methanol intoxication treatment is by tradition 0.2 g/L, although there’s no clear empirical support for this value [7]. Estimated Methanol concentration Calculated osmol gap × 10-3 × methanol molar mass = methanol concentration in g/kg = 73 × 10-3 × 34.02 = 2.5 g/kg Nevertheless the concentration was high enough to initiate CVVH-DF immediately. The, by gas chromatography measured methanol concentration, that was obtained later, was unfortunately much higher (4.4 g/L) and confirmed the absence of ethanol.