DEFINITIVE IDENTIFICATION OF AN EXCEPTIONALLY HIGH METHANOL CONCENTRATION IN AN INTOXICATION OF A SURVIVING INFANT - METHANOL METABOLISM BYFIRST-ORDER ELIMINATION KINETICS

Intoxication by methanol was identified in a five-week-old infant suff ering from moderate metabolic acidosis. The initial serum methanol at admission was 1148 mg/dL as measured by gas chromatography. The osmola l gap and formic acid concentrations were consistent with methanol int oxication. The child was treated with folic acid and a continuous etha nol infusion and survived without any apparent permanent problems. Bec ause expected toxic symptoms did not develop in this case, and the met hanol concentrations were at levels that might be deemed to be incompa tible with life, blood and urine samples were assayed by a specific en zymatic assay, and by gas chromatography/mass spectrometry (GC/MS). Po sitive results definitively confirmed the presence of methanol. In con trast to previous reports, the elimination of methanol in this case ap peared to following first-order kinetics. If hepatic ADH activity is l ow in neonates and young infants, another enzyme system such as catala se may be involved to explain this data. The lack of formic acid accum ulation may have been due to folic acid therapy.