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We found the report on “Acute methanol poisoning” very interesting1. The clinical image of this patient may confirm that he has the neurological problem due to metabolic acidosis. The neuroimaging finding in this patient may be a case with lentiform fork sign that is nonspecific for methanol intoxication2. With the lack of a good complete clinical history, it is difficult to judge whether the case is an actual neurological problem due to methanol poisoning. The important concern is on the laboratory parameters of the patient. The high plasma methanol level, but normal osmolar gap, should be discussed. The plasma methanol concentration reported could be fatal for the patient and the osmolar gap should not be normal. In methanol intoxication, the normal osmolar gap might be possible but the plasma methanol should not high3. The cause of high methanol has also been reported to be a false positive in patients with ketoacidosis or hyperglycemia4,5. The alcoholic ketoacidosis may present with a false positive high plasma methanol, acidosis with a normal osmolar gap and lentiform fork sign.

Methanol intoxication, lentiform fork sign, plasma methanol and osmolar gap