title: A Rare Cause of Metabolic Acidosis: Fatal Transdermal Methanol Intoxication in an Infant.
abstract: Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonic-clonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days. The patient's serum methanol level was 20.4 mg/dL. She was treated with fomepizole and continuous venovenous hemodialysis (CVVHD) in the pediatric intensive care unit, and methanol levels decreased to 0 mg/dL after 12 hours. During follow-up, massive edema and subarachnoid hemorrhage in the occipital lobe were detected by computed tomography of the brain. The patient died after 7 days.Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant.
authors.affiliation: From the *Department of Pediatric Infectious Disease, Medical School of Ege University; †Department of Pediatric Intensive Care, ‡Department of Pediatric Emergency Care, and §Department of Pediatric Nephrology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Zumrut
authors.initials: Z
authors.lastname: Sahbudak Bal
authors.forename: Fulya Kamit
authors.initials: FK
authors.lastname: Can
authors.forename: Ayse Berna
authors.initials: AB
authors.lastname: Anil
authors.forename: Alkan
authors.initials: A
authors.lastname: Bal
authors.forename: Murat
authors.initials: M
authors.lastname: Anil
authors.forename: Gamze
authors.initials: G
authors.lastname: Gokalp
authors.forename: Onder
authors.initials: O
authors.lastname: Yavascan
authors.forename: Nejat
authors.initials: N
authors.lastname: Aksu
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000931:Antidotes / Q000008:administration & dosage* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D000077604:Fomepizole; D006801:Humans; D007223:Infant; D000432:Methanol / Q000633:toxicity*; D011720:Pyrazoles / Q000008:administration & dosage* / Q000627:therapeutic use; D006435:Renal Dialysis; D013345:Subarachnoid Hemorrhage / Q000209:etiology*
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000077604:Fomepizole; D000432:Methanol