A patient presents with visual blurring described as 'being in a snowstorm', optic disc hyperemic edema, and high anion gap metabolic acidosis after drinking illicit alcohol. What is the specific antidote?
Answer and explanation
Correct answer: B. Fomepizole competitive ADH inhibitor
- Step 1: Ingestion of methanol results in metabolism by alcohol dehydrogenase into toxic formic acid, which inhibits cytochrome oxidase and damages the optic nerve and basal ganglia (putaminal necrosis).
- Step 2: Fomepizole is a potent competitive inhibitor of alcohol dehydrogenase that blocks the conversion of methanol into toxic formic acid, serving as the specific first-line antidote.
Answer
Fomepizole competitive ADH inhibitor.
Why not the others: Methylene blue is the antidote for methemoglobinemia, not toxic alcohols. Deferoxamine is an iron chelating agent. Pralidoxime reactivates acetylcholinesterase in organophosphate poisoning.
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