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Toxic alcohol ingestion — MCCQE Part 1 MCQ

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HardPoisoning/OverdoseToxic alcohol ingestionMCCQE Part 1

51-year-old man presents with visual blurring and abdominal pain after drinking homemade alcohol. He has high anion-gap metabolic acidosis and osmolar gap. Which of the following is the most appropriate next step?

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Correct answer: B — Give fomepizole and urgent toxicology/nephrology consultation

Give fomepizole and urgent toxicology/nephrology consultation is best because visual symptoms, osmolar gap and acidosis suggest methanol/toxic alcohol. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Antidote blocks toxic metabolite formation.

Reference: Canadian poison centre guidance