Manila, Philippines
As part of a series of lectures entitled, “Tox-Talks”, Dr. Chenery Ann E. Lim presented a lecture about methanol poisoning at Philippine General Hospital on July 4,2019. Dr. Lim is a program coordinator presently working with Oslo University Hospital and she has for a number of years worked for Médecins Sans Frontières (MSF/Doctors without Borders) The focus of the lecture by Dr. Lim was to raise awareness about the diagnosis and treatment protocols of methanol poisoning.
Although previously scheduled, Dr. Lim’s lecture to Medical Professionals comes on the heels of 2 suspected methanol deaths in the Philippines in late June. The focus of the lecture was to provide insight into why methanol poisoning is happening, how medical personnel can recognize the symptoms and begin immediate treatment to prevent deaths.
Dr. Chenery Ann E. Lim is a Philippine Native who has worked together with the Methanol Poisoning initiative (MPi) for more than two years along with many years of clinical experience and research on methanol poisoning. Dr. Lim’s colleagues have been in many areas of the world where methanol has cost thousands of lives.
Assigned to Indonesia by Médecins Sans Frontières, Dr. Lim received a crash course in mass methanol poisonings due to the ongoing proliferation of adulterated alcoholic beverages in that Country. In 2018, Dr. Lim returned to Indonesia to offer her expertise working with medical professionals in trying to contain the death toll from a mass methanol poisoning. The death toll in the April 2018 incident was officially listed at 82.
In her lecture to medical professionals at Philippine General Hospital, Dr. Lim began with the basics, explaining that methanol is used with regularity owing to its prices and easy accessibility. She went on to explain how methanol poisonings which leads to permanent health issues and death is a worldwide epidemic. She related how throughout the world illegal methanol, which is less expensive than ethanol, is used by illegal alcohol producers. It is easily used because it does not affect the taste of the drink, while at the same time mixes well. “Methanol as a product, it’s practically odorless, it’s tasteless,”
Dr. Lim noted that the high cost of alcoholic beverages throughout the world is a big incentive for its illegal production saying, “Majority of the times it’s for profit reasons. So, it’s because businessman or businesspeople want to make more profit so they will add methanol in the batch of brew.”
Countries where the price of alcoholic beverages is beyond the means of the average person or where laws limiting its accessibility are most susceptible to counterfeit alcohol according to the doctor. She brought up recent cases including the February 2019 mass poisoning in India where most of the over 100 deaths from cheap fake alcoholic beverages were among the poorest residents.
Home Brewed and Counterfeit Alcohol all Pose a Risk of Methanol Poisoning
Home brewing is a serious problem in countries where legal alcohol prices are extraordinarily high due to importation, tariffs and excessive government taxes. However, the problem of methanol is exasperated even in countries where legal alcohol is accessible because of the high profit potential for bootleggers who add methanol to counterfeit liquor. “There are some who adulterate their own drinks and add (methanol) to popular liquor like Smirnoff or Black Label,” Lim said.
According to Dr. Lim, methanol itself is not toxic. It becomes poisonous only when the body begins to break it down into formic acid. The doctor explained that because ethanol inhibits methanol from being transformed temporarily, the symptoms are delayed when they are consumed together. “You wait a bit of time for (methanol) to break down to formic. In the published literature, it takes a minimum of 6-12 hours,” she said. The Doctor continued, “The formic acid will then seep into the bloodstream and spread throughout the body. It is very toxic and has an especially toxic effect on the eyes and brain,”
Depending on the amount of methanol consumed, victims can expect severe vomiting, nausea, breathing difficulties, blindness and death. For doctors and patients alike Dr. Lim noted that the warning signs of methanol poisoning in the days following consumption can be confused with a severe “hangover” from regular alcohol intoxication. “If after more than 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.
The Antidote for Methanol Poisoning
There are two different antidotes for methanol poisoning. Fomepizole is a highly effective medicine, but due to its price it is not readily available in areas where methanol poisonings are more prevalent, such as in Asia. Doctors and researchers working with the Methanol Poisoning Initiative are calling on the World Health Organization to get involved to make Fomepizole readily available throughout the world and to focus their efforts on the countries with the most documented cases.
The second antidote for methanol poisoning is regular alcohol, or ethanol, which for decades has been known to be very effective. The problems with using ethanol are the side effects and the difficulties in maintaining the right levels in the victim. Therefore, although it sounds counterintuitive ethanol ingestion is a readily available antidote that medical professionals should use to buy time in the treatment of methanol poisoning.
Once in the hands of medical professionals, patients should be given more ethanol, as well as a bicarbonate that will act as a buffer to slow down the acidosis. This will buy time until the patient can be put on dialysis which will remove the methanol from the body.
Doctor Lim mentioned that awareness among health professionals is another factor in working towards ending the unnecessary deaths from methanol. She noted that methanol poisoning is a “great imitator”, often presenting symptoms that medical professionals mistake for other maladies. It is often mistaken for excessive intoxication, sepsis, and other less life-threatening illnesses.
Because methanol poisonings are often misdiagnosed the real number of victims are unknown. Throughout Europe there have been many documented cases of name brand liquor being counterfeited using methanol as its base. Everything from popular imported brands such as Jonnie Walker and Smirnoff to affordably priced wine such as Yellow Tail have been the subject of cases in Britain, Germany, Scotland and more.
The goal of Dr. Lim, Oslo University Hospital and Médecins Sans Frontières is to raise awareness of the problem. She noted, ““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,”
Doctors Need Funding to Counter Methanol Poisoning
Along with the efforts through the Methanol Poisoning initiative which includes a task force responding to outbreaks, systematic training and awareness campaigns, development of simplified treatment protocols, posters and animation movies the doctors have been working intensively to develop simplified diagnostic strips that will help detect methanol poisoning. Without the need for a laboratory, these strips can help with the diagnosis of methanol poisoning from a single drop of blood, they can be likened to a glucose strip used by diabetics. The first prototype of the device, MeTox was finalized more than two years ago, however a lack of funding has halted the development of this market ready product.
The innovative doctors who have worked tirelessly to develop this essential tool in the fight against the methanol poisoning epidemic need funding from governments, companies, philanthropists or individuals, to make this simple diagnostic tool a reality.
Editor’s Note: The Alcohol Industry is a multi-billion dollar a week industry, yet they are not on the front lines of fighting methanol poisoning which costs thousands of lives and damages many thousands more. It is the dedicated medical professionals who are on the front lines fighting methanol poisoning, raising awareness, saving lives and doing the research to effectively combat this epidemic. It would be a sliver of the annual marketing budget of the alcohol industry to fund MeTox, the Methanol Poisoning initiative, and Médecins Sans Frontières (MSF/Doctors without Borders).
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