title: Severe Methanol Poisoning with Supralethal Serum Formate Concentration: A Case Report.
abstract: OBJECTIVE
  To present a case of survival without visual and central nervous system sequelae at a formate concentration of twice the reported lethal level.
  
  
  METHODS
  This was a case of a 33-year-old man who ingested 1 liter of a toxic mixture of methanol and ethanol. Upon admission, he presented with anxiety, tachycardia and hypertension and had a serum formate level of 1,400 mg/l (normal range 0.9-2.1 mg/l), a methanol level of 806 mg/l (normal range 2-30 mg/l), an undetectable ethanol concentration and a normal lactate level. A 10% solution of ethanol and folinic acid was administered intravenously and two 8-hour sessions of intermittent hemodialysis were performed. The patient was discharged on the fifth day without sequelae of poisoning. The follow-up examinations 3 months and 2 years later revealed no damage to the basal ganglia. The patient had normal visual-evoked potential and findings on optical coherence tomography. The genetic analysis revealed a rare minor allele for the gene coding CYP2E1 enzyme of the microsomal ethanol oxidizing system.
  
  
  CONCLUSIONS
  The patient survived acute methanol poisoning without long-term sequelae despite a high serum level of formic acid upon admission.
authors.affiliation: Department of Occupational Medicine, Toxicological Information Center, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague 2, Czech Republic.
authors.forename: Olga
authors.initials: O
authors.lastname: Nurieva
authors.forename: Katerina
authors.initials: K
authors.lastname: Kotikova
mesh_terms: D000328:Adult; D000431:Ethanol / Q000506:poisoning*; D005561:Formates / Q000097:blood*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D000432:Methanol / Q000506:poisoning*; D011041:Poisoning / Q000628:therapy*; D006435:Renal Dialysis
chemical_list: D005561:Formates; C030544:formic acid; D000431:Ethanol; D002955:Leucovorin; D000432:Methanol