Body on Fire- Methanol Poisonings: The Forgotten Crisis
"My body felt like it was on fire", Methanol poisoning survivor in Indonesia
Forgotten Crisis
Methanol, methyl alcohol or wood alcohol is a clear, odorless liquid similar to drinking or ethyl alcohol, but is much more toxic. A fatal dose of methyl alcohol can be as low as 30 to 60 mL. Methanol poisonings and deaths occur quite frequently in poorer and Moslem countries as ethanol is either banned or taxed heavily, so that people drink methanol, either not aware that it is wood alcohol, or of it's toxicity. It is only when tourists to these countries are poisoned that the media pays attention.
Methanol Toxicity
Methanol by itself is not very poisonous, but the liver, over time, converts methyl alcohol into very toxic formaldehyde and formic acid metabolites. It can takes up to 12 hours or more for the symptoms of this slow poisoning becomes apparent. If the victim had also consumed alcohol, which inhibits the production of poisonous formaldehyde and formic acid, the symptoms may take even longer and the protective effect of alcohol is removed by its metabolism in the liver.
In addition to dialysis (which may not be available in poorer areas), the main treatment for methanol poisoning are alcohol, and expensive 4-methylpyrazole (fomepizole) which both inhibit the formation of the toxic metabolites of methanol.
"Body on Fire"
One 18 year old student in North Sumatra Province of Indonesia described what happened when she went out to a nightclub with a friend, where they were served with a local liquor made from grapes mixed with Red Bull. The mixed drinks tasted sweet because of the Red Bull so she thought the drinks were safe for human consumption.
But after a few glasses she felt dizzy and start to vomit and lose consciousness. When she woke she was at her friend's house. She kept vomiting until she could barely move. Her stomach cramped and convulsed and stung as if it was filled with acid.
Her eyelids felt heavy and painful and and her eyes stung and were watery if she only opened it for a short time. She stayed at her friend's house for 3 days until her vomiting subsided and recovered uneventfully.
Indonesia is a Moslem country where alcohol is forbidden, and so there is the shame and cultural disapproval of having consumed alcohol and some would say that she got what deserved. This causes a lot of methanol poisoning cases to go unreported.
There is also the difficulty of receiving treatment in the local hospitals as few have the expensive antidote fomepizole or dialysis machines, and staff are reluctant to administer alcohol as it is considered sinful. A ruling from the Indonesian Ulema Council in 2018, however, allowed medical practitioners to use ethanol in life or death situations such as methanol poisoning, but it would be dependent on the individual doctor's religious beliefs.
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It’s the Fermentation not the Distillation
Methanol or wood alcohol is produced commercially in the millions of gallons using mainly natural gas and a catalytic reactor. A misconception is that distillation of mash containing alcohol produces methanol.
Methanol is produced during the fermentation of fruit and especially fruit skin which contains pectin, but in small concentrations, not enough to cause poisoning. Distillation of the fermented mash does not produce additional methanol, but it may concentrate it to a small extent, perhaps enough to cause a more severe hangover, but not enough to cause death.
The natural fermentation of rice and carbohydrates and subsequent distillation could not produce enough methanol to poison the tourists in Laos. Instead, the cheap, industrial methanol is deliberately added to increase the moonshine volume and give it an added "kick".
Conclusion
Mass methanol poisoning will continue to be a forgotten crisis in poorer countries until better regulation of the production of alcoholic beverages and enforcement occur.
References
Llewellyn, A., "My body was on fire", Indonesians recall horror methanol poisoning symptoms after Laos tragedy, news.com.au, November 27, 2024
Tian, M., He, H., Liu, R., Zhu, B., and Cao, Z., "Fatal Methanol Poisoning with Different Clinical and Autopsy Findings: Case Report and Literature Review", Legal Medicine, 54: 6pp, 2022
Wargotz, E.S., and Wertner, M., "Asymptomatic Blood Methanol in Emergency Room Patients", American Journal of Clinical Pathology, 87: 773-775, 1987
Wigmore on Alcohol