Question 21.3 from the first paper of 2015 presents us with a story of a foreign sailor who was found unconscious. Immediately a sour flavour of intoxication and despair permeates through the case scenario. Prior to his descent into coma, he complained of visual disturbance. A "snowstorm", you might wonder. A gas is then offered, and the high anion gap found therein helps to form the impression of a methanol overdose. In a much less oblique fashion, Question 18.3 from the first paper of 2019 directly asked the trainees to list the biochemical features of methanol toxicity and discuss its specific management.
Toxic alcohols receive a more enthusiastic treatment elsewhere (Methanol and the other toxic alcohols, from the Acid-Base Disturbances collection of notes). This brief revision chapter is focused on answering CICM SAQs on toxic alcohol ingestion, or wherever a high anion gap metabolic acidosis raises such a differential. Kraut and Kurtz give this topic a thorough treatment in their 2008 article, which is probably the only thing you ever need to read on the subject. This article (as well as the relevant chapter from Goldfranks' ) formed the basis for this summary chapter.
Disorder | Toxin | Clinical and Laboratory Abnormalities |
---|---|---|
Alcoholic ketoacidosis |
|
|
Methanol intoxication |
|
|
Ethylene glycol intoxication |
|
|
Diethylene glycol intoxication |
|
|
Propylene glycol intoxication |
|
|
Isopropyl alcohol intoxication |
|
|
Kraut, Jeffrey A., and Ira Kurtz. "Toxic alcohol ingestions: clinical features, diagnosis, and management." Clinical Journal of the American Society of Nephrology 3.1 (2008): 208-225.
Henderson, William R., and Jeffrey Brubacher. "Methanol and ethylene glycol poisoning: a case study and review of current literature." Cjem 4.1 (2002): 34-40.
Morrow, Gregory P., et al. "In vivo kinetics of formate metabolism in folate-deficient and folate-replete rats." Journal of Biological Chemistry 290.4 (2015): 2244-2250.