A Case of Methanol Poisoning in a Child

We report the case of a girl admitted to the emergency room with a history of four hours' acute illness, characterized by nausea, vomiting, salivation, headache, blurred vision, and acidotic “Kussmaul” breathing. Arterial blood gases showed severe mixed acidosis, metabolic and respiratory with high anion gap. She had ingested the contents of a scent bottle containing methanol, which she thought was a soft drink bottle. The girl was managed with hemodialysis and strong intravenous hydration. She improved well and made a full recovery. 1. Introduction Methanol poisoning in children is rarely described in the literature; some cases are reported as accidental ingestion. For this reason, we report here a case of accidental methanol poisoning, discussing clinical and laboratory manifestations, management, and evolution. 1.1. Case Report A six-year-old female patient was admitted to the emergency room with her mother after four hours of disease characterized by nausea and vomiting of food content, abdominal pain, difficulty in breathing, salivation, headache, blurred vision, and psychomotor agitation. A physical examination found the following: weight 22？kg, blood pressure 80/60？mmHg, respiratory rate 32 breaths per minute, and heart rate 148 beats per minute. Her skin was pale, and her eyes were sunken, underactive, clouded, and irritable to stimulus. The patient was initially treated for severe dehydration resulting from food poisoning. However, with the development of wheezing and unresponsiveness to stimuli, she was transferred to the shock trauma unit for worsening respiratory distress, deep breathing with panting (Kussmaul) breathing, unresponsiveness to stimuli, Glasgow 10, to receive ventilator support. The laboratory findings were as follows: yellow urine, specific gravity 1.025, pH 7.0, trace glucose, leukocytes 8？10x field, erythrocytes 2-3x field, the leukocyte blood count 8,180x？mm3, segmented 69%, eosinophils 5%, lymphocytes 26%, Hb 12？g/dL, sodium 133？mEq/L, potassium 6？mEq/L, chloride 107？mEq/L, aspartate aminotransferase 4490？IU/L, alanine aminotransferase 8030？IU/L, and lactate dehydrogenase 2609？UI/L. Arterial blood gases showed severe mixed acidosis, metabolic and respiratory with high anion gap (pH 6.9, PaO2: 108？mmHg, PaCO2: 26？mmHg, and HCO3: 3？mEq/L). We therefore assumed the possibility of diabetic ketoacidosis, salicylate poisoning, or methanol poisoning. Evaluation of renal function showed urea 33？mg/dL and creatinine 0.6？mg/dL; glucose was normal. Therapy was initiated with vigorous hydration with sodium chloride 9/1000 and