Thursday, January 3, 2013

The Shining Moon

A drunk patient is brought in, complaining of visual blurring. He boards in the emergency department while he metabolizes to freedom, but as time goes on, he complains of central scotomata and then blindness. His mental status worsens with coma, and then a seizure which breaks on its own. Exam shows an afferent pupillary defect. You grab the ophthalmology resident and when he takes a look, he notes mydriasis, a retinal sheen, and hyperemia of the optic disc. CT scan of the head is normal. Labs show a bicarb level of 7 mEq/L with a normal lactate. Glucose is normal and there are no ketones in the urine. Tylenol and salicylate levels are normal. EKG is normal. You decide to give him IV ethanol (an unusual request, but the pharmacy gets to work compounding it).

Challenge: What's the most likely diagnosis?

Image is in the public domain.


Reflex Hammer said...

Methanol intoxication!

(My textbook had told us to use fomepizole, but whatever)

Jyrvindrial said...


Abdillahi said...

Alcohol blindness

Craig Chen said...

that's right! it's moonshine - yes you're right, fomepizole is the first line treatment, but alcohol works in a pinch.
The Shining Moon

This is methanol poisoning. Methanol is relatively harmless but is converted to formate by alcohol dehydrogenase and aldehyde dehdrogenase. Treatment is with fomepizole or ethanol (as a competitve inhibitor).

Source: UpToDate.