Killer Drink

• To save from paying high excise duty and or because of prohibition there is a thriving industry of illegal distilleries in India and elsewhere in which other substances are added to enhance the potency of the drink
• Hundreds of people die in India every year due to drinking of adulterated drinks.
• There is no record of people suffering from partial/ total blindness and damage to other organs

Methanol & Ethylene Glycol

• Methyl alcohol also known as Methanol, wood alcohol, wood naphtha or/ wood spirits commonly mixed in ethyl alcohol to manufacture denatured spirit for industry and hence available for adulteration in illicit distilleries.
• Ethylene Glycol is similarly used and may cause poisoning alone or with methanol
• Clinical picture of poisoning being similar, both must be suspected for proper diagnosis and treatment.

Methyl Alcohol

• The simplest alcohol CH3OH is a colourless volatile flammable liquid with strong alcoholic smell
• It is absorbed through skin, eyes, inhalation and gastrointestinal tract
• It is widely used in industry in plastics, paints, car parts, and is also used as fuel.
• A powerful poison ingestion of 10ml causes permanent blindness and 30 ml potentially fatal.

Methanol and Ethylene glycol

• Commonly present in houses as ingredients of antifreezes,vehicle windscreen washes, as solvent and for dirt removal.
• Used as an adulterant in ethanol to enhance its potency
• Taken by drunkards for the same reason or by mistaking for ethanol
• Both cause severe metabolic acidosis

Difference between Methanol & Ethylene Glycol

• Methanol causes pulmonary oedema and blindness
• Ethylene glycol causes hypocalcaemia and its complications
• These are correctly diagnosed if suspected
• These should be suspected if a very serious patient has unexplained and severe acidosis

Methyl alcohol

• Clinical picture
• Symptoms appear within 1 hr
• An asymptomatic period of several hrs up to 36 hrs may be seen
• Vertigo, vomiting, visual disturbance ( photophobia, blurred vision, visual field narrowing, blindness, dilated pupil) convulsions, signs of pulmonary oedema
• There may be pancreatitis with raised serum amylase level
• Usual fatal dose-100 to 250 ml
• Fatal period-24 to 36 hrs

First AID

• Good quality drink like whiskey, rum, gin, or brandy added in milk to be given to the patient to sip like a drink while being transferred to the hospital.

Methyl alcohol(Cont.)

• Treatment-
• Correction of acidosis, & haemodialysis may be required in addition to supportive care and administration of ethanol / fomepizole (Antizol) to slow down metabolism of methanol & ethylene glycol to their toxic metabolites.
• Other measures:
• Gastric lavage with Sodium bicarbonate
• Anticonvulsants
• Glucose saline with Sodibicarb
• Ethyl alcohol 10 to 20 ml 4 hrsly
• Hypocalcaemia to be guarded against
• Eyes covered and protected from light
• I.V Calcium in case of ethylene glycol poisoning

Methanol/ Ethylene glycol

• P.M.Findings
• Haemorrhagic inflammation in gastrointestinal tract
• Lungs may be oedematous
• All internal organs congested

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Medico-legal aspect

• Methyl alcohol produces drunkenness slowly but poisonous effect last longer for several days due to slow metabolism
• It is oxidised in to formaldehyde and formic acid in body which are toxic and also cause acidosis similarly ethylene glycol is metabolised in to glycolic acid and oxalic acid
• Accidental or deliberate adulteration of country made liquor is responsible for poisoning