Diabetic ketoacidosis as a complication of methanol poisoning; a case report

Abstract

Introduction Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA. Case presentation A 28-year-old male was referred to us with blurred vision and loss of consciousness three days after ingestion of 1.5 L of an unknown mixture of bootleg alcoholic beverage. He had history of insulin-dependent diabetes and had neglected his insulin shots on the day prior to hospital admission due to progressive loss of consciousness. Vital signs were normal and venous blood gas analysis showed severe metabolic acidosis and a methanol level of 10.2 mg/dL. After eight hours of hemodialysis, he remained unresponsive. Diabetic ketoacidosis was suspected due to positive urine ketone and blood sugar of 411 mg/dL. Insulin infusion was initiated which was followed by full awakening and extubation. He was discharged completely symptom-free after 4 weeks. Conclusions Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.

Fatal Methanol Poisoning Caused by Drinking Industrial Alcohol: Silesia Region, Poland, April–June 2022

“…The range of possible complications after exposure to methanol is wide. The literature describes, among others, rare cases of diabetic ketoacidosis [12], parkinsonism, and cerebral vasculopathy [13]. Currently used strategies for treating methanol poisoning include: administering the substances competing with methanol for alcohol dehydrogenase (ethyl alcohol, fomepizole) metabolism, increasing formaldehyde (folinic acid) metabolism [14], and hemodialysis [14,15].…”