Oral Boards Practice Cases

Case 1 - 22 yo F in a "coma" with normal vital signs. Not responding to Narcan and Dextrose. Found in a garage. On exam, she has sluggish and dilated pupils. pH 6.98, pCO2 29, bicarb 2

High concern for toxic alcohol ingestion: consult DPIC and nephrology for dialysis

• Fomepizole is the antidote for ethylene glycol only
• Can use ethanol drip to treat both ethylene glycol and methanol
• Replace folate aggressively and early 
• Methanol is metabolized to formic acid, if you give folate you can prevent methanol from going down the formic acid pathway