A 39-year-old man presents after drinking windshield-washer fluid. He has new visual blurring, pH 7.12, bicarbonate 8 mmol/L, anion gap 28 mmol/L,

Question

A 39-year-old man presents after drinking windshield-washer fluid. He has new visual blurring, pH 7.12, bicarbonate 8 mmol/L, anion gap 28 mmol/L, and osmolar gap 34 mOsm/kg. Methanol poisoning is strongly suspected and there is no ethanol co-ingestion. What is the most appropriate definitive management plan?

Accepted Answer

Give fomepizole, correct acidaemia, contact the poison centre, and arrange emergent high-flux haemodialysis

Answer

Send him home with measured ethanol drinks and repeat the osmolar gap the following morning

Answer

Give oral bicarbonate alone because correction of pH prevents further formate production

Answer

Use insulin and dextrose as the sole antidotal treatment until the visual symptoms resolve

Answer

Give naloxone and observe because an osmolar gap identifies opioid toxicity rather than toxic alcohol

Methanol poisoning — MCCQE Part 1 MCQ