Sequence of Unfortunate Events Leading to Persistent Acidosis Ending Fatally

Methanol intoxication causes high anion gap metabolic acidosis in addition to Central Nervous System (CNS) depression. Benzodiazepines in co-ingestion with other CNS depressants as alcohol can cause significant respiratory depression. Liraglutide is a novel antidiabetic agent whose acute overdose is not well studied. This case report aimed to present a case with combined intake of the three above-mentioned chemicals.

A case of 43-year-old male not diabetic, not an alcohol consumer, uses benzodiazepines regularly for sleep disorders. The patient unintentionally took 10 tablets of benzodiazepines over a period of 24 hours, aiming to sleep. He also consumed one glass of ethanol containing methanol (used for disinfection). The patient was on liraglutide subcutaneous injections for weight loss, with one injection 2 days before admission.The night before admission, the patient first felt light headed and complained of blurring of vision. The condition progressed and the patient was taken to the emergency department where he presented with coma, apnea, and shock.On the arrival of the patient, he was intubated and mechanically ventilated for having a disturbed conscious level and apnea.Laboratory testing identified severe persistent mixed type acidosis, hypoglycemia, and urinary toxicology screen was positive for benzodiazepine. IV fluids, vasopressors, Dextrose, bicarbonate, flumazenil, vitamin B, and folinic acid were given. Although urgent haemodialysis was undertaken, acidosis continued. The patient passed away after 37 hours of intensive care unit admission.

Combined exposure to alcohol and benzodiazepines can cause significant mixed type acidosis. CNS depression can result from combined alcohol, benzodiazepines, and prolonged hypoglycemia.