Co-ingestion of methanol and nitromethane: using falsely elevated creatinine as indicator for methanol antidote use.
OBJECTIVE
To report a case of co-ingestion of methanol and nitromethane in a child in order to heighten the awareness of false elevation of serum creatinine from nitromethane ingestion.


METHODS
Case report.


METHODS
Pediatric intensive care unit.


METHODS
A 4-yr-old previously healthy girl ingested an unknown quantity of "Blue Thunder" model-engine fuel, which consisted of methanol and nitromethane. The patient was treated with fomepizole for methanol ingestion using elevated creatinine level as a reason for treatment.


RESULTS
The patient was asymptomatic but her creatinine level increased ten-fold (from 0.4 mg/dL to 4 mg/dL) within 6 hrs. Blood urea nitrogen, anion gap, and osmolar gap remained within normal limits. When the serum creatinine level was measured with enzymatic method instead of Jaffe's method, a normal creatinine level was obtained. The falsely elevated creatinine level was due to nitromethane.


CONCLUSIONS
The falsely elevated serum creatinine levels due to nitromethane ingestion can lead to unnecessary therapeutic interventions. We intend to heighten awareness of this potential misstep by reporting this case.
Leonard
Charlene P
CP
Division of Pediatric Critical Care Medicine, Wolfson Children's Hospital, Jacksonville, FL, USA. charleneleonard2@yahoo.com
Akhtar
Javed
J
D000931:Antidotes / Q000627:therapeutic use*; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood*; D005189:False Positive Reactions; D005260:Female; D000077604:Fomepizole; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008697:Methane / Q000031:analogs & derivatives* / Q000097:blood / Q000506:poisoning; D000432:Methanol / Q000097:blood / Q000506:poisoning*; D009595:Nitroparaffins / Q000097:blood / Q000506:poisoning*; D011720:Pyrazoles / Q000627:therapeutic use*
D000931:Antidotes; D009595:Nitroparaffins; D011720:Pyrazoles; D000077604:Fomepizole; D003404:Creatinine; D008697:Methane; C008640:nitromethane; D000432:Methanol