Methanol toxicity in a newborn.
BACKGROUND
Methanol poisoning during human pregnancy rarely has been described. We report the first human newborn with a documented methanol concentration resulting from maternal exposure.


METHODS
A 28-year-old pregnant woman EGA 30 weeks with HIV infection and asthma presented to the emergency department in respiratory distress. She was acidotic (pH 7.17) with an anion gap of 26, and fetal bradycardia was noted. Her son was delivered by emergent C-section (birthweight 950 g, Apgars 1 and 3) and required aggressive resuscitation. During his hospital course, acidosis (initial pH 6.9) persisted despite fluid, blood, and bicarbonate administration. His mother also had persistent metabolic acidosis despite fluids, bicarbonate, and dopamine. Results of other laboratory tests on the mother included undetectable ethanol and salicylates and an osmolar gap of 41. An ethanol drip was initiated for the mother 36 h after admission when a methanol level of 54 mg/dL was reported. When consulted on hospital day 3, our regional poison center recommended hemodialysis for the mother and administering fomepizole and testing the methanol level of the newborn (61.6 mg/dL). Because the infant developed a grade 4 intraventricular bleed, no further therapy was offered, and he died on day 4. His mother died on day 10.


CONCLUSIONS
Fatal neonatal methanol toxicity can result from transplacental exposure.
Belson
Martin
M
National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. zqp2@cdc.gov
Morgan
Brent W
BW
D000138:Acidosis / Q000097:blood / Q000139:chemically induced; D000328:Adult; D001034:Apgar Score; D001249:Asthma / Q000150:complications; D002245:Carbon Dioxide / Q000097:blood; D019970:Cocaine-Related Disorders / Q000150:complications; D017707:Erythrocyte Transfusion; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008297:Male; D008431:Maternal-Fetal Exchange; D000432:Methanol / Q000097:blood / Q000506:poisoning*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000139:chemically induced; D012128:Respiratory Distress Syndrome / Q000139:chemically induced
D002245:Carbon Dioxide; D000432:Methanol