A 49-year-old woman with a history of chronic alcohol use disorder presented to the emergency department after 10 episodes of vomiting within hours of ingesting 15 standard drinks of gin. She was alert and oriented, hemodynamically stable, and her physical examination had normal findings. Serum toxicology screening demonstrated a serum ethanol level of 37.3 mg/dL (8.1 mmol/L) and a methanol level of 19.22 mg/dL (6.00 mmol/L) (normal range; <4.00 mg/dL [<1.25 mmol/L]). The patient denied any ingestion of industrial solvents or homemade alcohol and had no clinical symptoms of methanol ingestion, such as visual disturbances, altered mental status, or abdominal pain. However, additional bloodwork demonstrated an anion gap metabolic acidosis with a pH of 7.27, bicarbonate (HCO3-) of 10 mEq/L (to convert to mmol/L multiply by 1.0), carbon dioxide pressure of 22 mm Hg, an anion gap of 35, osmolar gap of 27, lactate level of 108.1 mg/dL (to convert to mmol/L multiply by .111) and elevated level of serum ketones. Her liver enzyme and creatinine levels were normal, and findings for salicylate and acetaminophen were negative.
Himmel ME, Lam K, Fralick M. Hemodialysis in a Healthy Patient—A Case of an Erroneous Laboratory ResultA Teachable Moment. JAMA Intern Med. 2016;176(4):431-432. doi:10.1001/jamainternmed.2015.8447