Abstract
BackgroundTransformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient’s case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil.Case presentationA 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium. He was found to have elevated anion gap acidosis, increased osmolal gap, and acute kidney injury. He had no evidence of rhabdomyolysis or hemolysis. Computed tomography of his head showed cerebral edema. He was resuscitated with intravenous fluids and bicarbonate. Three days later, he confessed taking transformer oil with suicidal intention. His clinical picture mimicked acute methanol intoxication. With an initial improvement in his neurological status, he started complaining of constant headache with episodes of agitation and delirium. His renal function continued worsening despite an adequate urine output. He showed a remarkable improvement in his neurological state after just one session of hemodialysis.ConclusionsThere is evidence that aged transformer oil contains methanol, and a patient who consumes it can present with features mimicking acute methanol intoxication.
Highlights
Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties
There is evidence that aged transformer oil contains methanol, and a patient who consumes it can present with features mimicking acute methanol intoxication
We report a case of a young man with altered mental status and high osmolal and anion gap metabolic acidosis along with acute kidney injury who later confessed taking transformer oil in a suicide attempt
Summary
The field of medicine is very challenging but rewarding at the same time. Taking a history from patients with altered sensorium is a difficult task for physicians, especially if the clinical scenario points to substance abuse. During the first 24 hours of admission, the patient showed remarkable improvement in his consciousness level; he was still delirious but started following commands His serum bicarbonate improved to 18 mEq/ L, and his white blood cell count decreased. After the first hemodialysis session, the patient’s BUN fell only slightly from 80 to 60 mg/dl, he showed a remarkable improvement in his consciousness level He became calm and alert, his agitation was almost alleviated, and his complaints of headache became less frequent. The patient’s headache subsided completely, and his consciousness level improved significantly, which further pointed to removal of certain substances via dialysis as the cause of altered sensorium and kidney injury He was discharged on day 12 with stable serum creatinine, which was completely normalized 10 days after discharge.
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