Review Question - QID 107516

A patient with a history of alcoholism presenting with symptoms of alcoholic ingestion with an increased anion gap metabolic acidosis and visual problems is most likely to be suffering from acute methanol poisoning. He should be treated with intravenous fomepizole (1st line) or ethanol (2nd line).

Methanol is a substance that is most commonly found in household cleaning products and homemade alcohol that is not correctly purified. Intoxication presents with symptoms similar to alcohol ingestion, but can also manifest with severe visual and metabolic disturbances. This is due to the metabolism of methanol into formaldehyde and formic acid by alcohol and acetaldehyde dehydrogenase. A build up formic acid damages the central nervous system along with the renal and cardiac tissues.

Figure A shows a view of the patient's retina through an ophthalmoscope significant for a large and swollen disk, significant for papilledema.

Incorrect Answers:
Answer 1: Naloxone can be administered for opiate toxicity.
Answer 2: Sodium bicarbonate can be administered for tricyclic antidepressant toxicity.
Answer 4: Flumazenil can be administered for benzodiazepine toxicity.
Answer 5: Glucagon can be administered for beta-blocker toxicity.