Methanol Intoxication with Brain Hemorrhage: Catastrophic outcome of late presentation

Methanol (CH3OH) is a highly toxic alcohol with a smell and taste similar to ethanol. It is found in a variety of commercial paint thinners, gasoline anti-freeze, windshield products, organic solvents, shellac varnish, washer fluid, photocopying fluids, perfumes, and in some eau de cologne. [1],[2] The lethal dose of methanol is 50-100 ml. [1] Methanol intoxication occurs after accidental or suicidal ingestion of the above mentioned liquids or, occasionally, it is due to the fraudulent adulteration of wine or other alcoholic beverages; [3] it is also frequently taken as an alcohol substitute, especially during times of ethanol restriction (wartime or prohibition). Its ingestion causes high anion gap metabolic acidosis from the production of formic and lactic acids and CNS disturbances ranging from inebriation and drowsiness to obtun­dation, seizure and coma. Selective toxicity of the optic nerve and basal ganglia are well­known features. [4], [5] When large amounts of methanol are ingested, death usually occurs within three days. [6] We report on a young patient with methanol intoxication who presented with severe high anion gap metabolic acidosis and massive intracerebral bleeding.