Suicidal Attempt with 99.8% Methanol: An Unusual Case

Objective: To report an intentional 99.8% methanol (analytical reference material) acute exposure. Case report: A 52 year old non drinker male was admitted 3 h after the ingestion of 150 mL 99.8% methanol, presenting nausea, vertigo and 6 episodes of vomiting, without other complaints. He had been under irregular psychiatric treatment for depression, using bupropion, clonazepan and oxicarbazepine for the last 4 months. This was his second suicidal attempt Physical examination showed no remarkable features. The first methanol serum result (70 mg/ dL) was obtained 10 h after the ingestion. A loading dose of 10% ethanol solution (7 mL/kg iv) was given, followed by a maintenance dose of 0.9-1.0 mL/kg/h/iv during the next 42 h (2.1 mL/ kg/h during hemodialysis). Folinic acid was administered during 48 hours. An eight hour course of hemodialysis was started 19 h after ingestion. The table below summarizes the main laboratory results according to time post-ingestion. Ophthalmologic evaluation and cerebral CT scan 4 days after admission revealed no changes. The patient was discharged at day four. Conclusion: Suicide attempt with high concentrated methanol (99.8%) is not common. A possible low alcohol desidrogenase activity phenotype, in a chromic alcohol abstinent person, may explain the lack of relevant acid-basic disturbances during the first 20 h from ingestion, despite the high methanol serum level. The good outcome may be attributed to the prompt admission, ethanol administration, and hemodialysis performed in the first 24 h after ingestion.