skip to main content

Methanol poisoning — RCPSC EM MCQ

Instant feedback + full explanation. One question, done properly.

HardToxicologyMethanol poisoningRCPSC EM

A 51-year-old has visual blurring, abdominal pain and tachypnoea after drinking homemade alcohol. pH is 7.09, bicarbonate 6 mmol/L, anion gap 32, osmolar gap elevated and creatinine rising. What is the immediate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Start fomepizole, bicarbonate and urgent dialysis assessment

The best answer is “Start fomepizole, bicarbonate and urgent dialysis assessment”. The presentation strongly suggests severe methanol poisoning with acidaemia, visual symptoms and renal injury. Fomepizole should be started promptly while acidosis is corrected and toxicology and nephrology arrange dialysis; delayed treatment permits further formate generation. Ethanol is not a safe unsupervised substitute and pyridoxine is not sufficient treatment for methanol.

Reference: Ontario Poison Centre: Methanol protocol: https://www.ontariopoisoncentre.ca/siteassets/pdfs/english/protocols/methanol-revised-final-oct-2025.pdf