Study of various clinical and laboratory parameters among 178 patients affected by hooch tragedy in Ahmedabad, Gujarat (India): A single center experience

Abstract

Introduction/Purpose:The outbreak of methanol poisoning described in this paper occurred in Ahmedabad, Gujarat, India in July 2009. Our intention is to share the experience of clinical features, laboratory investigations and their relation during this tragedy.Materials and Methods:Single center, retrospective study of clinical features and laboratory parameters of 178 cases of methanol toxicity treated at tertiary care hospital in Ahmedabad, Gujarat.Results:Maximum patients (39.8%, n = 45) were received in 48 h; Mean age of presentation was 41.9 ± 10.2 years. Most of them were men (175 out of 178). On presentation, 83% patients had gastro-intestinal symptoms, 46% had neurological symptoms, 73% had visual symptoms and 32% had dyspnoea. 62% had blurred vision, 10.5% had blindness. Patients with visual symptoms had high mean level of methanol (120.12 ± 23.12 vs. 55.43 ± 29.24, P = 0.014). On fundus examination 52.8% (n = 62) had bilateral hyperaemia of discs, 8.4% (n = 12) had bilateral disc pallor and 4.5% had papilledema (n = 5). Patients with hyperaemia of discs, discs pallor or papilledema, had higher mean methanol level (121.1 ± 32.2 mg% v/s 70.1 ± 23.2 mg%, P = 0.032). Mean of pH values was 7.17 ± 0.22 and bicarbonate was 12.3 ± 7.3 mmol/L. Both pH and bicarbonate levels correlated well with mortality and serum methanol level. Mean serum methanol level was 87.1 mg/dL, and correlated significantly with the mortality (53.1 ± 41 mg/dL v/s 121 ± 92 mg/dL, P value < 0.05).Conclusion:GI symptoms, neurological symptoms and breathlessness are important clue to ED physician for diagnose methanol poisoning. Visual symptoms and fundus findings correlate well with the methanol level. Arterial Blood Gas derived pH and bicarbonate levels correlate significantly with the methanol level and mortality.

Single center experience of managing methanol poisoning in the hilly state of uttarakhand: A cross sectional study

“…Provisionally, many such outbreaks of hooch tragedy have been reported not only from India but also from other parts of the world such as Kenya and Libya in 2013 and 2014, respectively. [12345] The outbreak highlighted multiple health challenges such as delay in onset of symptoms, variation in presentation and symptom profile, management difficulties including diagnosis and treatment, increased burden (economic and workforce) on health-care system, and high mortality and morbidity rates. Thus, collaborative efforts of both public health departments and emergency medical services of the hospital to raise awareness of such outbreaks and for timely treatment of these patients are pivotal to prevent mortality and morbidity.…”

“…This delay occurs as a result of a conversion of methanol to formaldehyde and then to formic acid by enzyme alcohol dehydrogenase. [4] Gastrointestinal symptoms such as pain abdominal, nausea, and vomiting are the most common symptoms in patients with methyl alcohol poisoning. When consumed in large amounts, these patients present commonly with altered sensorium and coma in the later stages.…”

“…Many a time, if not reported, these outbreaks go unnoticed. [12345] Methanol, an organic solvent, has been used for industrial purposes and is prepared from wood by the destructive distillation process. The minimal reported lethal dose of methanol is 15 ml of 40% methanol.…”

“…However, methanol levels cannot be obtained immediately, and the treatment should be initiated as soon as possible based on the point-of-care markers such as bicarbonate and lactate levels and base deficit. [4] The metabolism of methanol is caused by enzymatic degradation by dehydrogenase into formaldehyde and formic acid. These byproducts are highly reactive and bind to tissue proteins, leading to oxidative damage to the cells.…”

Fluorometric trace methanol detection in ethanol and isopropanol in a water medium for application in alcoholic beverages and hand sanitizers

“…Worldwide, hundreds of economically constrained people are dying every year because of consumption of methanol (MeOH) contaminated illicit liquors. [1][2][3] In the countryside, use of crude fermentation methods and improper distillation are the main culprits for the MeOH contamination in ethanol (EtOH). In some cases, unavoidable MeOH formation during standard fermentation processes is also a major concern.…”