Methanol Poisoning Leading To Brain Death: a Case Report.

Jakub Glowala,Jeremy B. Richards

doi:10.2478/jccm-2021-0039

Jakub Glowala, Jeremy B. Richards

Open Access

https://doi.org/10.2478/jccm-2021-0039

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Abstract

IntroductionThe COVID-19 pandemic has put increased stress on medical systems, infrastructure, and the public in expected and unexpected ways. This case report summarises an unexpected case of methanol poisoning from hand sanitiser ingestion due to changes in industry regulations, increased demand for cleaning products and severe psychosocial stressors brought on by the pandemic. Severe methanol toxicity results in profound metabolic disturbances, damage to the retina and optic nerves, and potentially death.Case PresentationThe patient was a 26-year-old male with alcohol use disorder who presented with one day of nausea, vomiting, and abdominal pain after consuming hand sanitiser. Within a few hours, the patient had suffered multiple seizures, cardiac arrests and required admission to the ICU for emergent management of methanol poisoning. EEG and brain perfusion imaging were performed to confirm brain death, given concerns about the cranial nerve exam after methanol poisoning.ConclusionsWhile rare, methanol toxicity remains a potentially fatal poisoning in the United States and worldwide. When healthcare and public resources are strained, healthcare professionals must consider particularly abnormal presentations. In patients suspected of brain death from methanol toxicity, cranial nerve examination may be unreliable. Therefore, additional testing is necessary to confirm brain death.

Highlights

IntroductionThe COVID-19 pandemic has transformed the modern world, and many of the indirect harms to patients will only become evident in retrospect
The COVID-19 pandemic has put increased stress on medical systems, infrastructure, and the public in expected and unexpected ways
With the increased use of harsh cleaning agents, strained production lines potentially vulnerable to contamination, and messaging advocating consumption of potentially lethal substances, patients may be susceptible to poisoning [2]. This case describes an atypical source of methanol toxicity in a young male with alcohol use disorder

Summary

Introduction

The COVID-19 pandemic has transformed the modern world, and many of the indirect harms to patients will only become evident in retrospect. With the increased use of harsh cleaning agents, strained production lines potentially vulnerable to contamination, and messaging advocating consumption of potentially lethal substances, patients may be susceptible to poisoning [2] This case describes an atypical source of methanol toxicity in a young male with alcohol use disorder. He had a heart rate of 80bpm, blood pressure 94/52mmHg on the four vasopressors described above; an oxygen saturation of 97% on volume assist-control ventilation with a tidal volume of 440cc, respiratory rate of 34 breaths per minute, positive end-expiratory pressure of 8cm H2O, and a fraction of inspired oxygen of 50%. Targeted temperature management (TTM) was initially deferred given the severity of his condition His alcohol panel was positive for methanol but otherwise negative.

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