A 39 year old carpenter has taken two bottles of liquor from the local shop. After about and hour, he develops confusion, vomiting and blurring of vision. He has been brought to the emergency depament. He should be given:
The clinical features, especially ocular features like blurring of vision are suggestive of methyl alcohol poisoning. Moreover, Methyl alcohol is commonly used to adulterate ethyl alcohol. Impoant facts related to Methanol poisoning: 1) Cheap liquor is commonly adulterated by Methanol which leads to toxicity after consumption by poor people. Adulteration with Methanol is done because it is presumed to give the kick effect earlier with a smaller dose. Methanol is cheap and easily available. 2) Methanol as such is not a toxic agent. Methanol is metabolized to formaldehyde (by alcohol dehydrogenase) and then to formic acid (by aldehyde dehydrogenase), and these metabolites of methanol are responsible for retinal toxicity as well as metabolic acidosis. 3) Ethanol or 4 methyl pyrazole (fomepizole) are used for the treatment of methanol poisoning. They preferentially compete with methyl alcohol for the same enzyme alcohol dehydrogenase and prevents the metabolism of methanol which is then excreted unchanged in the urine.
Naloxone
Diazepam
Flumazenil
Ethyl alcohol
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