(Solved): Suspected or confirmed Methanol poisoning Meet criteria for fomipezole or ethanol? Serum methano ...

Suspected or confirmed Methanol poisoning Meet criteria for fomipezole or ethanol? •Serum methanol > 20 mg/dL, or Documented recent hx of ingesting toxic amounts of methanol AND osmolal gap > 10 mOsm/kg, or Strong clinical suspicion of methanol poisoning AND at least 2 of following: 1. Arterial pH <7.3 2. Serum bicarb < 20 mEq/L 3. Osmolal gap > 10 mOsm/kg YES Give folic acid or folinic acid (leucovorin) If arterial pH <7.3, administer bicarbonate If fomepizole available, administer 15 mg/kg IV Meet criteria for hemodialysis? ANY of the following: Arterial pH <7.25-7.30 • Visual signs/symptoms Deteriorating vital signs despite intensive supportive care Renal failure Significant electrolyte disturbance unresponsive to conventional tx Serum methanol 2 50 mg/dL" YES Hemodialysis May consider withholding hemodialysis if treat with fomepizole Dignincant ocoryto istorice unreapontane to convenonaro Serum methanol 2 50 mg/dL." YES *May consider withholding hemodialysis if treat with fomepizole Hemodialysis American Academy of Clinical Toxicology Guideline (Barceloux et al. Clin Toxicology, 2002) Figure 2. American Academy of Clinical Toxicology Guidelines. (Barceloux et al., Clinical toxicology, 2002). Upon admission to the Emergency Department (ED), the patients laboratory results showed a pH of 7.27. According to clinical management guidelines, bicarbonate should be administered to this patient. Given your knowledge on acid/base balance, WHY do you think this is the case? O increase serum bicarbonate levels neutralise the excess acids, to increase plasma pH to within normal range allows acids to be excreted by vomiting O neutralise the excess acids, to decrease plasma pH to within normal range