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Background: Acute methanol poisoning is a fatal illness. Several Atypical presentations could make it difficult to suspect the diagnosis.
Case Report: A 50 years old male known chronic alcoholic presented to the emergency department with severe acute abdominal pain nausea and vomiting. He rapidly deteriorated within 2 hours to develop confusion and seizures, was found to have double gap severe metabolic acidosis and elevated serum methanol. The patient was managed with Continuous Renal Replacement Therapy (CRRT) and supportive measures. He gradually improved and was discharged with no neurological or visual complications.
Conclusion and Recommendations: Acute methanol toxicity should be expected if the alcoholic patient develops a rapid neurological deterioration and shows double anion gap acidosis.
Health authorities should provide the serum formic acid test for diagnosis and the fomepizole as a preferable antidote. Until then, supportive treatment, intravenous ethanol and CRRT should be immediately started in these patients.