title: Mind the gap: a case of severe methanol intoxication.
abstract: We report a case of a 37-year-old woman with non-insulin-dependent diabetes on sitagliptin, an alcohol abuser who was brought unresponsive to the emergency department of our hospital. On arrival, the patient was intubated and mechanically ventilated due to a low Glasgow Coma score of 3/15. Initial laboratory testing identified profound high anion gap metabolic acidosis. Owing to the dubious circumstances and the depth of acidosis, methanol and ethylene glycol intoxication was suspected. Further evaluation revealed a significantly increased serum osmolal gap. Pending volatile compound screen, fomepizole was started and urgent haemodialysis undertaken. Subsequent brain MRI identified changes in putamen of bilateral basal ganglia, suggestive of methanol intoxication. The patient was later found to have an initial methanol level of 237 mg/dL. She was successfully extubated on day 2 of hospitalisation, with residual cognitive and visual deficits.
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Salik
authors.initials: S
authors.lastname: Nazir
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Melnick
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Shabana
authors.initials: S
authors.lastname: Ansari
authors.affiliation: Department of Pulmonary and Critical Care, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Haitham T
authors.initials: HT
authors.lastname: Kanneh
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000000981:diagnostic imaging* / Q000473:pathology; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D000432:Methanol / Q000506:poisoning*; D000068900:Sitagliptin Phosphate / Q000627:therapeutic use
chemical_list: D000068900:Sitagliptin Phosphate; D000432:Methanol