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Methanol poisoning — SCE Acute Medicine MCQ

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EasyToxicology and OverdoseMethanol poisoningSCE Acute Medicine

A 63-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show illicit alcohol, visual symptoms, osmolar gap and severe acidosis. What is the most appropriate next step in management?

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Correct answer: E — Give fomepizole and arrange urgent haemodialysis

The key discriminator is that illicit alcohol, visual symptoms, osmolar gap and severe acidosis, which makes Give fomepizole and arrange urgent haemodialysis the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF fomepizole