A Death from Consuming 'Alcohol'

BY ​MICHELE STYBEL; LAURIE-ANN ANTOINE; JENNIFER TUONG; AHMED RAZIUDDIN, MDA 54-year-old man with a past medical history of COPD presented to the ED with shortness of breath that had started an hour earlier. He was alert and oriented, but also agitated, combative, and unable to provide an adequate history.He said he was a heavy smoker and drinker and that he had been smoking and consuming alcohol when the symptoms started. He also reported past Cannabis use.He was in acute respiratory distress with BiPAP in place, restless, and diaphoretic. Respiration was labored with bilateral expiratory wheezing but no significant cardiac and abdominal findings. His vital signs were normal except for an elevated respiratory rate of 32 bpm. His pulse oximetry was 91% on 100% FiO2.Lab tests revealed a lactic acid of 10 mmol/L. An arterial blood gas analysis revealed a pH of 6.95 and HCO3 of 7.2 mEq/L. The most likely differentials were ethylene glycol or methanol ingestion. His methanol level was 136 mg/dL, so methanol poisoning was identified as the cause. He was also diagnosed with anion gap metabolic acidosis and acute exacerbation of chronic obstructive airway disease. Sodium bicarbonate and fomepizole were given.Rapid DeteriorationHe developed acute respiratory failure about three hours later, and was unresponsive and then intubated. His blood pressure in the ICU began trending down, and his mean arterial pressure was consistently below 65 mm Hg with fluid resuscitation...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research