Methanol poisoning by ingestion is nowadays a trending problem in worldwide with high mortality and morbidity. It is a serious social, medical and economic problem. Methanol poisoning is involved mostly by accidental ingestion, for mass killing and for suicidal purpose also. Methanol is also known by another words “Methyl alcohol” or “Wood alcohol”. It is generally obtained by distillation of wood having molecular formulae CH3OH, it is a colourless liquid. There is only a one carbon atom difference between Ethanol (ethyl alcohol) and methanol but the appearance and taste is more similar to ethanol, it is inexpensive and potent. Because of these properties methanol is the mostly used adulterant in illicit liquors. Mixing of small amount of methanol in ethanol is known as spurious alcoholic preparation. This spurious alcoholic preparation leads to toxicity after ingestion. It generally happens in the slum areas and villages because there is a huge production of illicit liquor prepared locally from molasses or jaggery, mahuva, coco-plant, rice, and also from leftover stuff of fruits   etc. sometimes industrial alcohol is also mixed in it to increase the conc. So, it will give quick effect after consuming. [1]

Methanol itself is not toxic but Yes! Its metabolite formed in liver i.e. Formaldehyde and formic acid cause toxicity. This metabolite is highly fetal due to its property of CNS depressants which can cause a permanent blindness. There is lots of hooch tragedies happened in India because of consuming illicit liquor (moonshine). The reason behind most of the hooch tragedies was the methanol. [2] It is very important to know the signs and symptoms of the methanol poisoning to treat the patient. As the properties of methanol are very similar to ethanol it taken misunderstood that the patient is in intoxication of alcohol and hangover even if it is in methanol poisoning. This misunderstanding is responsible for death of victim/patient because of late treatment and antidote given. It has been today very important to study the particular signs and symptoms of methanol poisoning so the medical doctors can identify and diagnose it as soon as possible.

Sign and Symptoms:

The signs and symptoms of methanol poisoning resemble as it get absorbed in blood. Depending upon the concentration in blood the signs will appear. So, the route of administration is proportional to the sign. Methanol can absorbed by many routes by its volatile nature. The routes of administration are ingestion, inhalation, dermal mostly. Methanol poisoning cannot cause until it metabolized to formaldehyde/formic acid by enzyme ADH (alcohol dehydrogenase).

The symptoms are generally divided in two sets: initial and second set of symptom. Initial symptoms are appeared within 12-24 hr and after it second set of symptom arises.

Initial Symptoms:

The initial symptoms start with sign of intoxication with the CNS (Central Nervous System) effects such as CNS depression, headache, nausea, vomiting, lack of co-ordination and confusion begins within the 12-24 hrs. CNS effect can occur when blood methanol level reach 200mg/l. [1, 5]

Second set of symptoms:

After 10-30 hr the person who is intoxicated with methanol will start experiencing second set of symptoms that is followed by visual disturbances and then severe acidosis which can cause death. The minimal lethal dose is 1gm/kg of the body weight or can say 15-500ml. The complete vision loss occurs in the second set of symptom. Blurred vision strongly supports the diagnosis of methanol poisoning. The visual disturbance problem starts with the blurred and indistinct vision to eye pain followed by blindness. Blindness is seen when blood methanol level reaches 500mg/l. [1, 5-6]

Ophthalmoscopy/funduscopy is useful for eye examination. In which doctors do test on retina, vitreous humor and optic disc. That allows seeing inside the fundus of the eye by using opthalascope/funduscope. The changes seen in eyes in methanol poisoning is as below.

1.     There is increase in the blood flow of the optic nerve.

2.     White striated edema appears.

Microscopic and Macroscopic findings:

Microscopic and macroscopic study is done by the MRI (Magnetic Resonance Imaging) and CT scan (computed tomography). This can show the imaging of brain having cerebral and cerebellar haemorrhage, Ischemic changes in the brain and optic neuritis, putaminal necrosis and haemorrhage, brain stem petechial haemorrhage, thalamic and hypothalamic haemorrhage.

Methanol poisoning epidemic happens under the COVID-19 pandemic, march 2020.

As there are lots of hooch tragedies, suicidal and homicidal cases happened because of methanol poisoning, in between this an interesting case took place on early march 2020 by consuming methanol. This poisoning case occurred in Iran South-western Khuzestan province and its southern city of Shiraz. The current issue going on pandemic COVID-19 made everyone crazy, everyone is living under a fear that he may not get suffer to this disease and the rumour spread in Iran that drinking high proof alcohol can cure COVID-19 disease. This rumour spread on social media forwarded and forwarded again. This message of rumour suggested that a British school teacher and other cured themselves of the Corona Virus with the whiskey and honey. This message forwarded with mixing content with the use of alcohol based hand sanitizer but someone took it wrongly and the belief was spread that drinking of high proof alcohol can cure the COVID-19. The fear of virus mixed with the poor education and falsely use of internet saw hundreds of people suffered to death and thousands of people fall sicken by drinking Bootleg alcohol containing methanol. It is very sad to know that 5 year old baby is also involved in this methanol poisoning. [7-9]

References

Chapter 7, HOOCH POISONING, A forensic guide for crime investigators. http://nicfs.gov.in/wp-content/uploads/2017/01/Hooch-Poisoning.pdf 13/04/2020.

List of alcohol poisoning in India, from Wikipedia the free Encyclopedia. https://en.wikipedia.org/wiki/List_of_alcohol_poisonings_in_India 13/04/2020.

Methanol poisoning outbreak, Information note, World Health Organization. https://www.who.int/environmental_health_emergencies/poisoning/methanol_information.pdf 13/04/2020.

Clary John J. (Eds.). (2013). the toxicology of methanol (pp. 47-59). Hoboken, New Jersey: John Wiley and Sons. Inc.

Cook M.R., Bergman, F.J., Cohen, H.D., Gerkovich, M.M., Graham, C., Harris, R.K., and Siemann, L.G. (1991) Effects of methanol vapors on human neurobehavioral measures. Health Eff. Inst. Research Report 42, 1–45.

Barceloux, D.G., Bond, G.R., Krenzelok, E.P., Cooper, H., and Vale, J.A. (2002) American academy of clinical toxicology practice guidelines on the treatment of methanol poisoning. Clinical Toxicology. 40 (4), 415–446.

Believing fake news, Iranian turns to alcohol to prevent COVID-19, Bootleg booze kills27, the new Indian express. 09march2020 https://www.newindianexpress.com/world/2020/mar/09/believing-fake-news-iranians-turn-to-alcohol-to-prevent-covid-19-bootleg-booze-kills-27-2114502.html 14/04/2020.

Hundreds die of poisoning in Iran as fake news suggests methanol cure for virus. The times of Israel 27 march 2020. https://www.timesofisrael.com/hundreds-die-of-poisoning-in-iran-as-fake-news-suggests-methanol-cure-for-virus/ 14/04/2020.

Multiple dead in Iran after drinking methanol to cure coronavirus. Republic world 28 march 2020. https://www.republicworld.com/world-news/rest-of-the-world-news/300-dead-in-iran-after-they-drink-methanol-to-cure-covid-19.html 14/04/2020.

Author :-  Aarti Jyotiram Kamble, Intern at Legal Desire (2020)

She is from Pune, perusing Masters in Forensic Science (specialization in Forensic Chemistry and toxicology) from Government Institute of Forensic Science, Mumbai, Mumbai University and she have completed her bachelor’s in Forensic Science, from Yashwantrao Chavan Institute of Science,Satara, Shivaji University, Maharashtra. She have published paper on “Determination of age through handwriting characteristics” in 2nd International conference on “Medico-legal issues and crime scene investigation” organized by legaldesire media and insights. She have done internship at CFSL-CBI mumbai in Documents, Photography and in Fingerprint division. Also have done training at CFSL-Pune in Question Documents Division. She worked with Maharashtra-Mumbai Police on the AMBIS (Automated Multimodal Biometric Identification System) project. She is also working with “Spylens Forensic Investigation” a private investigation lab in New Mumbai.