Antifreeze is always not Ethylene Glycol

We describe a case of methanol intoxication resulting from antifreeze ingestion. A 23 year old Hispanic male presented to emergency room with vomiting, abdominal pain and blurry vision 48 hours after ingestion of gas line antifreeze in a suicidal attempt. The physical examination was unremarkable on presentation. Initial laboratory data was significant for a severe anion gap metabolic acidosis with an elevated osmolal gap. Urine examination under microscope did not demonstrate any crystals. With concern for ethylene glycol or methanol intoxication, the patient received intravenous fomepizole and was started on hemodialysis. He received a total of two sessions of hemodialysis and completed the fomepizole treatment along with administration of folic acid, thiamine and pyridoxine with an improvement in the acidosis and osmolal gap. His toxicology screen revealed an elevated methanol level (72 mg/dl) with normal ethanol and ethylene glycol levels. As methanol, but not ethylene glycol poisoning, can cause injuries to the optic nerve and retina resulting in blindness, an ophthalmologic examination is critical and was normal in this patient. After correction of his intoxication, the patient was subsequently discharged to a psychiatric unit.We caution that all antifreeze is not ethylene glycol, depending on the type, it may be methanol. Thus, obtaining information on the type of antifreeze is an important part of history taking in suspected cases of toxic ingestions and to predict organ involvement as well as plan of treatment.