A man arrives after drinking windscreen-washer fluid. He has blurred vision, Kussmaul breathing, pH 6.91, bicarbonate 6 mmol/L, anion gap 34 mmol/L

Question

A man arrives after drinking windscreen-washer fluid. He has blurred vision, Kussmaul breathing, pH 6.91, bicarbonate 6 mmol/L, anion gap 34 mmol/L and measured osmolal gap 38 mOsm/kg. What is the definitive emergency treatment bundle?

Accepted Answer

Give fomepizole and IV bicarbonate, and arrange urgent haemodialysis with NPIS/renal support

Answer

Give ethanol orally and observe until the osmolal gap normalises without extracorporeal treatment

Answer

Give naloxone and IV bicarbonate, and arrange haemofiltration only if pupils become pinpoint

Answer

Give sodium nitrite and thiosulfate, and arrange urgent hyperbaric oxygen therapy

Answer

Give fomepizole alone and defer dialysis until the serum methanol result is available

Pulmonary-renal syndrome — SCE Acute Medicine MCQ

A man arrives after drinking windscreen-washer fluid. He has blurred vision, Kussmaul breathing, pH 6.91, bicarbonate 6 mmol/L, anion gap 34 mmol/L and measured osmolal gap 38 mOsm/kg. What is the definitive emergency treatment bundle?