Methanol Toxicity: An Unintended Consequence of the COVID-19 Pandemic

Introduction: Although “parent alcohols” such as methanol and ethylene glycol are relatively non-toxic, they can lead to profound toxicity after being metabolized by alcohol dehydrogenase. Methanol poisoning is characterized by a high anion gap metabolic acidosis and can have a variety of central nervous system manifestations ranging from inebriation to coma and seizures, with afferent pupillary defect a sign of advanced methanol poisoning. Early recognition and treatment are key. Here we present a case of severe methanol toxicity secondary to hand sanitizer ingestion early in the COVID-19 pandemic. Case: A 54-year-old man with a history of alcohol use disorder presented to the Emergency Department after being found down and unresponsive near the front door of his home. Earlier that day he was “acting strange” according to his girlfriend. She left their home to get help, and upon her return found him in the front yard unresponsive and having seizure activity. Upon arrival to the Emergency Department he was afebrile, hypotensive, and tachycardic. He was unresponsive so he was emergently intubated. Physical exam was significant for asymmetric, dilated, and fixed pupils. Labs were significant for a bicarbonate of 5, potassium of 7.2, an anion gap of 28, and an osmolar gap of 177. His methanol level was 396. Despite dialysis he progressed to multi organ failure and his family decided to transition to comfort care, soon after which he expired. After further questioning it was discovered that he had been drinking hand sanitizer in an effort to get intoxicated as they were out of alcohol in the house. The bottle found in the home was reported to the FDA. Upon their review it was removed from store shelves due to methanol contamination and potential risk to others. It is believed that this brand of hand sanitizer was a new brand sold during the COVID-19 pandemic shortage and had a false ingredient label. Discussion: This patient had many of the characteristic signs and symptoms of methanol poisoning and was an unfortunate example of how devastating the outcome can be. However, it also highlights how the COVID-19 pandemic has had many unintentional medical consequences as a result of socioeconomic health disparities, the challenge of treating substance abuse disorder, and poorly regulated consumer products.