"Half-dead Drunk and A Bad Virus": A Case of Methanol Poisoning With Covid-19 Infection

Abstract

Introduction

Covid-19 virus infection can be deadly and to have a methanol poisoning on top of this can be doubly deadly. We present a case of methanol toxicity in a patient who also had the virus infection.

Case Description

A 42-year-old Burmese gentleman was brought to the department by the prehospital team after being found to be less responsive after drinking 'whiskey' with friends the night before. He had second dose of vaccine just a day before.  On arrival, his GCS was E1V1M1, BP 119/76 mmHg, PR 80 beats/min, RR 20 breaths/min and SpO2 100% under high flow mask. He had one episode of generalized tonic-clonic fitting more over the left side, lasting for 15 secs before aborting spontaneously. He was intubated for airway protection. He had severe metabolic acidosis with pH <6.8 and the HCO3 was incalculable. He was treated for alcohol poisoning and covered for aspiration pneumonia. There was a slight Acute Kidney Injury with urea 2.4 mmol/L, creatinine 172 μmol/L and K 5.4 mmol/L.  Liver function was normal. He was given IV Ethanol, IV Folinic acid, NaHCO3 and subsequently dialysed.  Chest Xray showed bilateral opacities more over the right side.  CT Brain plain showed no intracranial bleeding. While awaiting ward admission, tracheal aspirate PCR came back as positive. Patient was started on IV Dexamethasone 8mg stat and once daily along with subcutaneous Heparin 5000 units twice daily. He was then admitted to Covid ICU. Serum methanol was detected. The pH normalized post dialysis.

Discussion and Conclusion

During the pandemic, deadly events such as toxic alcohol ingestion can happen on top of being infected by Covid-19. High index of suspicion is necessary as shown in this case. Treatment needs to be started early based on clinical assessment and precautions taken for protection as well test for Covid-19.