A 47 year old male presents to the Emergency Department with altered mental status. Initial labs reveal: VBG: 6.91/17/50; BMP: 140/7.1/105/<5/20/1.0; gluc 130; ALT 42; AST 56; Ammonia 327. What is the likely culprit?
Methanol. Hyperammonemia has been associated with methanol and ethylene glycol intoxication. The proposed mechanism is that N-acetylglutamate is necessary for the incorporation of ammonia into the urea cycle and the acids produced from the metabolism of methanol and ethylene glycol may result in a decrease synthesis of N-acetylglutamate and thereby result in ammonia accumulation.
Haroz R et al. Hyperammonemia: A possible marker for methanol and ethylene glycol intoxication. Clin Tox 2005; abstract 124.