During the last week of June, there was a buzz online among Filipinos about a so-called “craft” alcoholic beverage that supposedly resulted in the poisoning of two people. One viral post alleged that one of the victims slipped into a coma then died.
A couple of days later, the Department of Health confirmed that the 2 patients showed symptoms of methanol poisoning — nausea, vomiting and loss of consciousness.
The Food and Drug Administration (FDA) also revealed that the alcoholic drink, which is still being tested for methanol, was not registered with the agency.
As the drink in question is being analyzed for methanol content, the public has wondered about what makes alcoholic beverages lethal, specifically those caused by methanol. How is methanol poisoning distinguished from ordinary intoxication? How can it be detected? If a person exhibits symptoms, what immediate treatment can be used to save a life?
On Thursday, Dr. Chenery Ann Lim, program coordinator from Oslo University Hospital in Norway, discussed a number of issues during a lecture with doctors of the Philippine General Hospital.
Originally from the Philippines, Lim was working with Médecins Sans Frontières (Doctors Without Borders) when she was assigned to Indonesia, where she was exposed to methanol poisoning outbreaks due to the proliferation of bootleg liquor.
Last year, she returned to Indonesia to help deal with the same type of poisoning in Bandung, which left more than 80 people dead.
WHY METHANOL POISONING HAPPENS
According to Lim, people become poisoned by alcohol drinks when it is mixed with methanol.
“Methanol as a product, it’s odorless, it’s tasteless,” she said, explaining that it has been used as an extender for ethanol (legal alcohol) since it does not dilute the taste of drinks.
“Majority of the times it’s for profit reasons. So it’s because businessman or business people want to make more profit so they will add methanol in the batch of brew.”
Lim said this often happens in countries where alcohol is expensive or sales are limited. In February, about a hundred people died in India because of toxic alcohol.
“Majority of the time they will brew their own because the prices are so high,” Lim said.
Many are not aware of methanol’s serious consequences, while others ignore them because of profit, she added.
“There are some who adulterate their own drinks and add (methanol) to popular liquor like Smirnoff or Black Label,” Lim said.
Like in other countries, methanol used as an alcoholic extender is illegal in the Philippines, said FDA officer-in-charge Eric Domingo.
“Methanol (in alcoholic drinks) is prohibited here. But there are some liquor (allowed) that have methanol content because it’s derived from the natural fermentation process or distillation process,” Domingo told reporters last July 2.
HOW METHANOL BECOMES POISONOUS
Lim said naturally produced methanol is safe. It only becomes poisonous when it is ingested and converted into formic acid and formate in the body.
When mixed with ethanol, methanol doesn’t immediately metabolize. However, Lim explained that ethanol exits the body through exhalation, leaving methanol in the body to break down.
“You wait a bit of time for (methanol) to break down to formic. In our studies, it takes a minimum of 6 hours,” she said.
The formic acid will then seep into the bloodstream and spread throughout the body. “It is very acidic and it damages the eyes,” Lim said.
According to Doctors Without Borders, depending on the amount, methanol can cause blindness and death.
HOW TO COUNTER METHANOL POISONING
While initial symptoms are similar to regular alcohol intoxication, Lim said people should be alarmed when they are still experiencing a severe hangover after 12 hours.
“If after 12 hours you are still not feeling well . . . You are vomiting, you feel weak and your head hurts, you need to consult a doctor,” she said.
While it may sound counterintuitive, Lim said taking hard drinks will help a victim if it will take time to reach a hospital, because ethanol contained in such drinks will help slow the breakdown of methanol.
“Even if you’re not sure if the drink has been contaminated with methanol . . . It’s still going to be an antidote (because it has ethanol),” she said.
At the hospital, methanol poisoning patients are then given more ethanol, a bicarbonate to buffer the acidosis then folic acid to convert the toxic formate into carbon dioxide and water.
“But it’s dialysis that will really remove the methanol from your body,” Lim said.
LACK OF AWARENESS
Lim said not a lot of people are aware about methanol poisoning, not only the public but also among health professionals.
Because methanol poisoning is a “great imitator,” it can be diagnosed as sepsis and other illnesses, Lim said.
“There are a lot of gaps in the awareness and the knowledge of it even among health professionals. It’s still a topic that is not widely known like diabetes or hypertension,” she added.
While methanol poisoning in the Philippines is not as widespread as it is in countries such as India, Indonesia and Malaysia, Lim said there is no way of knowing just how many have been affected by it.
Lim explained that it is also a sensitive topic and victims are ashamed because they are made to believe that it is their fault.
Last year, the FDA issued a warning against unregistered alcoholic drinks after more than 10 people died in Laguna and Quezon City after drinking “lambanog,” a local alcoholic drink made from coconut.
She said her group has also come across people in the provinces who lost their eyesight because of methanol poisoning.
“It could just be the tip of the iceberg,” Lim said.
To increase awareness, the Oslo University Hospital, where Lim works, has been working with Doctors Without Borders for a Methanol Poisoning Initiative. Whenever there is an outbreak anywhere in the world, the university’s team is sent out to help or train health professionals.
They are also pushing for the World Health Organization to help make the antidote fomepizole be more accessible worldwide.
“Fomepizole is really effective but it is expensive, and in Southeast Asia either it is not registered or not available because of the cost,” Lim said.
They are also working on a machine that will help detect methanol poisoning. Currently, it is hard to diagnose methanol poisoning but studies are being done to allow detection through blood and breath samples.
During her lecture, Lim showed the mouthpiece of a breathalyzer they are developing. However, she said it will take a few years before it can be distributed. On top of the need for more studies, they will also have to make a more portable version — the prototype machine weighs 25 kilograms — so it can be easily used around the world.