In the Prohibition-bound Bihar, 13 people died of suspected alcohol poisoning on Tuesday. The deceased, all from Gopaganj area, are suspected to have consumed spurious country-made liquor commonly called hooch.

The main culprit in poisoning from hooch is the presence of large quantities of methanol. Traces of methanol are found in legally made and licenced alcoholic drinks like beer while country made liquor, when not brewed with care, can contain large quantities of methanol. Methanol is essentially a toxic industrial- standard alcohol, which is added to increase the potency of liquor. Currently, methanol is easily available in the market, and has many industrial applications including the manufacture of varnishes among other products.

A World Health Organisation information note on methanol poisoning says that “problems arise when higher concentrations are formed during incorrectly managed distillation processes, but more particularly when methanol is deliberately added to fortify informally-produced spirits and illicit alcoholic drinks”.

The document noted that apart from India, numerous outbreaks have been noted in Cambodia, the Czech Republic, Ecuador, Estonia, Indonesia, Kenya, Libya, Nicaragua, Norway, Pakistan, Turkey and Uganda.

Recurring tragedy

In 1991, after a hooch poisoning incident in Mumbai, a state committee was formed, which suggested laws to deter unauthorised storage of methanol. They also suggested adding a bitter or foul-smelling substance to methanol to make it undrinkable. The committee also suggested that containers selling methanol should prominently display skull and crossbones indicating that it is dangerous for human consumption.

Methanol gets absorbed in the gastrointestinal track of the person drinking it. It can also enter the system through the skin and by inhalation. Toxic effects arise from methanol metabolising in the body to first form formaldehyde. Formaldehyde, which is thought to be a cancer causing agent, is quickly converted in to formic acid.

In the normal course of body activities – like when small quantities of methanol are ingested from fruits and vegetables or produced in trace amounts in the body itself - formic acid is flushed out of the body during excretion. When large amounts of methanol enter the body with copious amounts of spurious liquor, formic acid accumulates in body tissues leading to acidosis.

“Depending on the amount of alcohol consumed, the effects kick in," said Dr R Bharmal, dean of BYL Nair Hospital, Mumbai. "A large dose of methanol can start having an effect on the body within two hours.” Nair Hospital had treated many of the patients during the hooch tragedy of 2015 at a slum in north Mumbai when 95 people died of methanol poisoning.

The time factor

In the first few hours after consuming methanol a person may become drowsy, unsteady and disinhibited says the WHO note. These symptoms often pass off as standard drunkenness and so often results in delayed medical care. After some time, a victim starts to develop a headache, is given to vomiting, and experiences abdominal pain and vertigo. He may start to hyperventilate and feel breathless.

Often, the victims need intensive medical care. “The enzyme produced in the body block the receptors in the body and have a disastrous effect on the patient," said Bharmal. The poisoning affects all the organs of the body including the eyes, kidneys and liver.

Often a patient's vision is often affected, and cases of severe poisoning result in blindness. Coma, convulsions, and death from respiratory arrest may ensue. Getting quick treatment is essential in surviving methanol poisoning and even if a life is saved, the victim's eyesight may not be, said Bharmal.

The only treatment or antidote is to alcohol itself. “We give diluted ethanol intravenously to nullify the enzymes,” said Bharmal.

As the victims of methanol poisoning from hooch in India are generally from economically and socially backward communities, they are less equipped to capacity to seek specialised care.