A seaman with blindness and confusion

doi:10.1136/bmj.b3929

Published 30 September 2009, doi:10.1136/bmj.b3929
Cite this as: BMJ 2009;339:b3929

Endgames

Case report

A seaman with blindness and confusion

Leo J Schep, toxicologist¹, Robin J Slaughter, poison information officer¹, J Allister Vale, clinical toxicologist², D Michael G Beasley, medical toxicologist¹

¹ National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand, ² National Poisons Information Service (Birmingham Unit) and West Midlands Poisons Unit, City Hospital, Birmingham

Correspondence to: L J Schep leo.schep@otago.ac.nz

The first 150 words of the full text of this article appear below.

A male member of a fishing boat crew presented at a rural hospital36 hours after having consumed a large amount of "bootleg" (homemade) vodka. He had loss of vision and seemed to be confused.He was immediately evacuated by helicopter to a large urbanhospital emergency department. On arrival, the patient developedseizures followed by circulatory shock.

1 What is the most likely diagnosis?

2 What investigationsshould be undertaken to confirm the diagnosis?

3 How are theosmolal gap and the anion gap calculated?

4 What treatmentis required urgently?

5 Which antidote should be initiated?

6What other treatment should be given?

1 This patient most likely has methanol poisoning.

2 Acid-basestatus and serum methanol concentration should bemeasured toconfirm diagnosis. If the latter is not possible,calculationof the osmolal gap and the anion gap might be helpful.

3 Theosmolal gap is . . . [Full text of this article]