OBJECTIVE: To present a case of survival without visual and central nervous system sequelae at a formate concentration of twice the reported lethal level. CLINICAL PRESENTATION AND INTERVENTION: This was a case of a 33-year-old man who ingested 1 liter of a toxic mixture of methanol and ethanol. Upon admission, he presented with anxiety, tachycardia and hypertension and had a serum formate level of 1,400 mg/l (normal range 0.9-2.1 mg/l), a methanol level of 806 mg/l (normal range 2-30 mg/l), an undetectable ethanol concentration and a normal lactate level. A 10% solution of ethanol and folinic acid was administered intravenously and two 8-hour sessions of intermittent hemodialysis were performed. The patient was discharged on the fifth day without sequelae of poisoning. The follow-up examinations 3 months and 2 years later revealed no damage to the basal ganglia. The patient had normal visual-evoked potential and findings on optical coherence tomography. The genetic analysis revealed a rare minor allele for the gene coding CYP2E1 enzyme of the microsomal ethanol oxidizing system. CONCLUSION: The patient survived acute methanol poisoning without long-term sequelae despite a high serum level of formic acid upon admission.

Department of Occupational Medicine Toxicological Information Center 1st Faculty of Medicine Charles University Prague and General University Hospital Prague 2 Czech Republic

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Zakharov S, Pelclova D, Urban P, et al. Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features. Clin Toxicol. 2014;52:1013–1024. PubMed

Liesivuori J, Savolainen H. Methanol and formic-acid toxicity – biochemical-mechanisms. Pharmacol Toxicol. 1991;69:157–163. PubMed

Zakharov S, Pelclova D, Navratil T, et al. Methanol and formate elimination half-life during treatment for methanol poisoning: intermittent haemodialysis vs. continuous haemodialysis/haemodiafiltration. Kidney Int. 2014;86:199–207. PubMed PMC

Barceloux DG, Bond GR, Krenzelok EP, et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40:415–446. PubMed

Zakharov S, Nurieva O, Navratil T, et al. Acute methanol poisonings: folates administration and visual sequelae. J Appl Biomed. 2014;12:309–316.

Zakharov S, Navratil T, Pelclova D. Fomepizole in the treatment of acute methanol poisonings: experience from the Czech mass methanol outbreak 2012–2013. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014;158:641–649. PubMed

Zakharov S, Kurcova I, Navratil T, et al. Is the measurement of serum formate concentration useful in the diagnostics of acute methanol poisoning? A prospective study of 38 patients. Basic Clin Pharmacol Toxicol. 2015;116:445–451. PubMed

Roberts DM, Yates C, Megarbane B, et al. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med. 2015;43:461–472. PubMed

Hubacek JA, Pelclova D, Seidl Z, et al. Rare alleles within the CYP2E1 (MEOS System) could be associated with better short-term health outcome after acute methanol poisoning. Basic Clin Pharmacol Toxicol. 2015;116:168–172. PubMed

Roy M, Bailey B, Chalut D, et al. What are the adverse effects of ethanol used as an antidote in the treatment of suspected methanol poisoning in children? J Toxicol Clin Toxicol. 2003;41:155–161. PubMed

Acute and chronic blood serum proteome changes in patients with methanol poisoning