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5. Methanol ingestion
The initial presentation mimicked a toxic alcohol ingestion. Methanol ingestion is a classic cause of anion gap metabolic acidosis and blindness - the acidosis predominantly due to formic acid, the oxidation metabolite of methanol. Ethylene glycol classically presents with acute renal failure and anion gap acidosis – the acidosis predominantly due to oxidative metabolites glycolic acid and oxalic acid. Diabetic ketoacidosis or alcoholic ketoacidosis usually does not present with blindness or this severe an acidosis. The patient certainly has acute renal failure from urinary tract obstruction but this is usually not associated with blindness.
Which of the following additional laboratory tests should be obtained? (click on correct answer to move to next panel)