AbstractLactic acidosis is due to increased serum lactate (>5.0mmol/L) leading to decrease in blood pH. Alcoholic keto-acidosis is one of the several etiologies where serum lactate level rarely exceeds 3mmol/L. Here we present a case of 59yr old male presented to ED with c/o abdominal pain and multiple episodes of vomiting following consumption of alcohol. On examination, patient was tachypneic, tachycardic with BP of 90/60mmHg. Arterial blood gas showed severe metabolic acidosis with a pH of 6.96, pCO2 of 21.4, pO2 of 57.1, HCO3 of 4.7 and Lactate of 14.48. On probing history, attenders revealed consumption of illicit liquor by patient on previous night giving rise to suspicion of methanol toxicity