US EPA

1141929 

Journal Article 

Methanol toxicity in a newborn infant 

Belson, M; Baker, J; Morgan, B 

2002 

1 

Journal of Toxicology: Clinical Toxicology
ISSN: 0731-3810
EISSN: 1097-9875 

DART/TER/3000062 

40 

5 

English 

Background: Methanol toxicity has not been previously described in a human during the neonatal period. Early recognition of methanol poisoning is vital to prevent the toxic effects of its metabolites. Case Report: A 28-year-old female G3P2002, who was 28 weeks pregnant, presented to the emergency department in respiratory distress. She had a history of asthma, cocaine abuse, and a hospitalization 2 months earlier for unexplained metabolic acidosis. On this presentation, she was acidotic (ABG pH 7.17, PCO2 10, BD 22) with an anion gap (AG) of 26 and fetal bradycardia was noted. Her son was delivered by emergent C-section: 950 gram birth weight with Apgars of 1 and 3. He required 2 doses of epinephrine and airway intubation for resuscitation. His ABG at 1 hour: pH 6.9, PCO2 36, BD 26. During his first 2 days of life, his perfusion was poor and his acidosis persisted (AG greater than 27) despite fluid, blood, and bicarbonate administration. The mother also had persistent metabolic acidosis (pH less than 7.1) despite fluids, bicarbonate, and dopamine. Other initial maternal labs included: lactic acid 2.9 mmol/L (1.4-4.1), undetectable ethanol and salicylates, and an osmolar gap of 41. An ethanol drip was initiated 36 hours after admission when a methanol level of 54 mg/dL was reported. Our regional poison center was consulted on hospital day 3. Recommendations included adjusting the ethanol drip, starting dialysis, and a repeat methanol level for the mother (0 mg/dL). Antizol and a methanol level were recommended for the newborn (62 mg/dL). Because the infant developed a grade 4 intraventricular bleed, no further therapy was offered and he expired on day 4. The mother developed renal failure and expired on hospital day 10. Conclusion: This is the first reported case of methanol toxicity from transplacental exposure. Persistent acidosis in a newborn may be suggestive of maternal drug toxicity. Early recognition of toxicity may improve outcome.