Methanol Poisoning Important Differential in a Refractory Metabolic Acidosis with A Diabetic Patient Suspecting Ketoacidosis: A Case Report
Author(s):
U K Mallick , S M Hossain Shahid , Mohammad Asaduzzaman, Aflatun Asha, Sayem Mohammad Farhad, SuptaBardhan, Nahin Siddique, Nahid Sarker, Omar Faruq and Ashikur Rahman
The incidence of methanol intoxication is less common in Bangladeshi population. Early and aggressive management with bicarbonate, ethanol and hemodialysis in patients having significant toxicity will decrease mortality and improve patient’s outcome. Our experience of SLED in haemodynamically unstable patient with inotrpic support may improve outcome.
Case presentation: A-45 years old male bussinessman, diabetic and hypertensive was admited into cabin with history of restlessness, blurring of vision and breathlessness 1 day. Inspite of conservative treatment after 10 hours his general condition gradually detoriated, so he shifted to ICU and kept in mechanical ventilator. His laboratory results showed a severe high anion gap metabolic acidosis not corrected by sodibicarb and adequatefluid resuscitation. His neurological codition of patient was detoriating and MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. After conservative treatment, his general condition was deteriorated and acidosis was not corrected rather than he developed acute kidney injury so haemodialysis (SLED) was started after taking nephrology consultation. After giving 3 sessions of SLED, metabolic acidosis was corrected with normalization of renal function. His vital signs stabilized and he was extubated subsequently. After six months in a follow-up patient complained total blindness and fundal photography showed bilateral optic atrophy.
Conclusions: We conclude that in case of severe metabolic acidosis, methanol intoxication always should kept in mind in a patient of Diabetes Mellitus suspecting DKA .Early initiation of haemodialysis is very effective to reverse renal and metabolic abnormalities inspite of haemodymis unstability. Metabolic improvements do not equal to healing the patient, especially permanent neurological deficit like blindness may persit.