A 57 year old male presents to the ED in December via EMS obtunded and was found unresponsive. He cannot provide any history, but EMS asks you to check his instagram because before he was found unresponsive he kept yelling out, “just made the dopest boomerang”. It turns out the patient was found walking staggeredly downtown and telling passerbys he sees “snow everywhere”.  Bystanders made an insta post of the patient making an insta post, with holiday sparkle filter and caption #catchingthechristmasspirit. However one bystander was a physician and actually decided to help. He has tremors on initial exam and borderline hypotensive.

Which of the following is correct?

A. Initially, there is a raised osmolar gap followed by anion gap elevation

B. The presence of calcium oxalate stones is specific for ethylene glycol poisoning

C. Hemodialysis is ineffective at removing methanol

D. Activated charcoal has a role if used in the initial presentation

References:

Bekka R, Borron SW, Astier A, et al. Treatment of methanol and isopropanol poisoning with intravenous fomepizole. J Toxicol Clin Toxicol 2001; 39:59.

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Blake Briggs