Acute methanol poisoning with bilateral diffuse cerebral hemorrhage: A case report

Table 1 Time line and vital signs

Days (since ingestion)	Time	Events	BP (mmHg)	HR (bpm)	SpO2 (%)	Glasgow Coma Scale
Day 1	8:00	Blur vision
	15:30	Chest tightness and breathless	140/100	120	99	E4V5M6 (15)
	17:00	Admission to emergency department	150/112	108	85	E2V2M4 (8)
	18:00	CT scan of chest (Figure 2A) and head (Figure 3A)	130/88	78	88	E2V2M4 (8)
	19:00	Seizure, endotracheal intubation	58/32	43	60	E1V1M1 (3)
	19:30	Toxicology test
	21:15	CTA of pulmonary artery and aorta (Figure 2B)	92/49	117	99	E1VTM1
	21:30	Admitted to ICU	53/33	110	100	E1VTM1
	22:30	First course of CRRT (59 h)	172/90	95	98	E1VTM1
Day 2		Toxicology report confirmed AMP	140-152/70-78	60-65	96-100	E1VTM1
Day 4		Hemorrhage at left putamen (Figure 3B)	134-153/75-85	75-110	96-100	E4VTM1
		Second course of CRRT (62 h)
Day 10		Extubation	98-123/55-78	65-125	96-100	E4V2M1
Day 19		Hemorrhage aggravated (Figure 3C)	90-130/58-80	61-75	95-99	E1V1T1(3)
Day 29		Discharge	100/64	66	99	E1VTM1

BP: Blood pressure, HR: Heart rate, SpO₂: Pulse oxygen saturation; CT: Computed tomography; ICU: Intensive care unit; CRRT: Continuous renal replacement therapy; AMP: Acute methanol poisoning.

Table 2 Results of laboratory blood tests in the Emergency Department

Items	Results	Abnormality	Normal range
White cell count (× 109/L)	15.23	↑	3.5-9.5
Proportion of neutrophils (%)	58.8	Normal	40-75
Hemoglobin (g/L)	202	↑	130-175
CRP	< 1	Normal	0-10
Glucose (mmol/L)	8.8	↑	3.6-6.1
Creatinine (μmol/L)	139	↑	57-111
Total Cholesterol (mmol/L)	6.71	↑	2.8-5.18
Triglyceride (mmol/L)	4.56	↑↑	0.51-1.7
ALT (U/L)	28	Normal	9-50
AST (U/L)	40	Normal	15-40
Myocardial enzyme
Troponin I (ng/mL)	0.011	Normal	0-0.023
Creatine kinase MB isoenzyme (ng/mL)	3.6	Normal	0-7.2
Myoglobin (ng/mL)	131	↑	23-112
BNP (pg/mL)	34.6	Normal	< 100
Coagulation
Prothrombin time (sec)	11.3	Normal	9.4-12.5
Prothrombin activity (%)	96	Normal	70-130
Thrombin time (sec)	16.3	Normal	10.3-18
Activated partial thromboplastin time (sec)	34	Normal	25.4-38.4
D-dimer	2125	↑↑	0-255
Arterial blood gas
PH	6.797	↓↓	7.35-7.45
PaCO2	37.5	Normal	35-45
PaO2	82.5	Normal	80-100
SpO2	85.1	↓	95-100
Base excess (mmol/L)	-30.2	↓↓	(-3)-(3)
HCO3-	4.4	↓↓	22-27
H+	159.5	↑↑	35.5-44.7
A-aDO2 (mmHg)	29.4	↑	0-20
Lactic acid (mmol/L)	>15	↑↑	0.4-2.2

CRP: C-response protein; ALT: Alanine transaminase; AST: Aspartate aminotransferase; BNP: Brain natriuretic peptide; PaCO_2: Partial pressure of carbon dioxide; PaO₂: Partial pressure of oxygen; A-aDO₂: Alveolar-arterial differences for oxygen; SpO₂: Pulse oxygen saturation.

Table 3 Arterial blood gas monitoring until the end of the 2^nd course of continuous renal replacement therapy

Items	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Normal range
PH	6.86	7.24	7.34	7.41	7.46	7.47	7.35-7.45
PCO2 (mmHg)	32	31	39	29	27	27	35-45
PO2 (mmHg)	101	141	121	137	109	114	80-100
SpO2 (%)	90	99	98	99	99	99	95-98
Base excess (mmol/L)	-27.7	-12.8	-4.8	-5.2	-3.4	-2.8	(-3) -(3)
HCO3- (mmol/L)	5.7	13.3	21	18.4	19.2	19.7	22-27
Lactic acid (mmol/L)	11.6	1.1	2.2	1.7	1.3	1.2	0.5-2.22

PaCO_2: Partial pressure of carbon dioxide, PaO₂: Partial pressure of oxygen, SpO₂: Pulse oxygen saturation.