Reaching a diagnosis of methyl alcohol toxicity in a comatos
Case Report
A 29-year-old female was brought to the emergency room in an unconscious state of about 3-h duration. She was apparently asymptomatic when seen last. There was no specific history pointing toward any likely cause of unconsciousness. On examination, she was deeply comatose. Glasgow coma scale score was 3. Pupils were 3 mm, equal and reacting to light. Oculocephalic reflexes were present. Pulse rate was 92/min and blood pressure was 70 mmHg systolic. She was in respiratory distress. The patient was intubated and mechanically ventilated. Dopamine was started. Hematological tests were normal. Biochemical investigations showed elevated serum creatine phosphokinase (CPK) (1280 U/L) and uric acid (8.7 mg%). Arterial blood gasses showed severe metabolic acidosis (pH 7.1), with high anion gap (30 mmol/L). A brain magnetic resonance imaging (MRI) was obtained on day 2 of admission after hemodynamically stabilizing her. T2-weighted [Figure 1] and fluid-attenuated inversion recovery [Figure 2] images showed bilateral symmetrical hyperintense lesions involving lentiform nucleus. Mild perilesional edema was also noted.....