In Turkey, methanol is allowed as an universal spirit content in stove fuel, paint, and adhesive cleaners in shoemaking. In daily life, many people continue to deal with pain by self-medicating with alcohol, but this case shows how Turkish people use spirits transdermally, not orally, for pain because of religious beliefs. There are no references to epidemiologic studies about transdermal spirit use for medical purposes. Due to its ability to depress the central nervous system (CNS), methanol slows down the brain and nervous system and does deliver a certain amount of pain relief. It also has muscle relaxing and sedating properties. Methanol is used in the production of many materials in industry and is a common laboratory solvent. About 40% of methanol is converted to formaldehyde and from there into other products (
Local, regional, and national traditions against poisoning by the need to cut us how to get out. All cases in the literature regarding transdermal methyl alcohol poisoning have been reported from Turkey.
Methanol poisoning is classically characterized by central nervous system depression, metabolic acidosis, and visual changes. However multiple other organ systems are also affected. The severity of poisoning correlates more with the level of acidosis than the methanol levels (
Poisoning typically induces nausea, vomiting, abdominal pain, and mild central nervous system depression. If it progresses, uncompensated metabolic acidosis develops and visual function becomes impaired, ranging from blurred vision and altered visual fields to complete blindness (
6). In this case, only cloudy vision and difficulty of movement was seen, which was the result of slow metabolism of transdermal intoxication of methanol. The patient had no signs or symptoms of intoxication in fundoscopy. Iscan et al. reported a case of bilateral total optic atrophy due to transdermal methanol intoxication. In that case, the patient was wrapped with methylated spirit-soaked materials for 6 - 7 hours, and after two days came to the hospital with nausea, vomiting, and unconsciousness ( 7). Onder et al. reported acute blindness and putaminal necrosis in methanol intoxication ( 8). Transdermal methanol absorption is slow, so before the beginning of the patient’s lethal symptoms, he was taken to the ED so any visual complication was seen. We think that end-organ damage has been caused because of delayed discovery and late treatment of patients.
Laboratory tests for a patient with suspected methanol poisoning should include an arterial blood gas analysis, a chemistry panel (sodium, potassium, chloride, bicarbonate, glucose, blood urea nitrogen, creatinine, calcium, and magnesium levels), serum osmolarity, creatine kinase level, and ethanol level. The diagnosis of methanol poisoning should be considered in a patient with an unexplained acidosis. It is important to understand that acidosis will not present immediately after exposure. In many hospital and clinical laboratories, methanol level test results are not available in a timely manner to assist with initial medical decision making. In such circumstances, the osmolar gap may be used as a surrogate marker for toxic alcohol levels (
2). We calculated osmolar gap (26.9) and identified a high osmolar gap with severe metabolic acidosis in our patient, so we planned hemodialysis for treatment. Serum levels of methyl alcohol could not be measured in this patient because the measuring centers are closed on weekends.
The basic principles of treatment for both methanol and ethylene glycol poisoning include initial resuscitation, providing cardiopulmonary support, preventing formation of toxic metabolites, correcting acidosis, and enhancing the clearance of parent compounds and toxic metabolites. Alkalization, folic acid support, oral or intravenous ethanol, fomepizole, and hemodialysis are administered for this purpose (
9). Fomepizole, a competitive inhibitor of the alcohol dehydrogenase enzyme, was approved recently as an antidote for methanol intoxication in adults ( 10). Ethanol increases the inhibitory effects on the alcohol dehydrogenase enzyme. Indications for urgent hemodialysis after methanol or ethylene glycol ingestion (or exposure) are refractory metabolic acidosis pH < 7.25 with anion gap > 30 mEq/L and/or base deficit less than –15, visual abnormalities, renal insufficiency, deteriorating vital signs despite aggressive supportive care, electrolyte abnormalities refractory to conventional therapy, and a serum methanol or ethylene glycol level of > 50 mg/dL ( 2). Antidotal treatment could not be given to this patient because there were no antidotal drugs in the hospital, so alkalization with HCO 3 was applied.
Methanol poisoning as the result of oral intake is seen more often in patients presenting to the emergency department. However, in our case transdermal absorption resulting in methanol intoxication was seen, highlighting that transdermal absorption leading to methanol poisoning should be kept in mind for patients presenting to the emergency department.
The absence of serum methanol analyses for diagnosis makes the study poor regarding evidence. In addition, the antidote treatment could not be applied as fomepizole and ethanol are not available in the hospital or poison control center.