1. LEARNINGS FOR EMS FROM
GUJARAT HOOCH TRAGEDY

2. • Methanol poisoning is fairly common in
our country.
*June 2009: Eight die in Orissa's
Bolangir
*May 2009: 170 die in Karnataka /
TN
*April-March 2009: Over 30 die at
Delhi
*January 2009: 23 die in Kolkata
• Being cheap, easily available and potent,
it is the first adulterant of illicit liquors.
• It goes by the names of khopadi, lattha,
dalda, bewada, french polish, etc.
• Methanol poisoning, whether sporadic or
mass poisoning is an acute medical
emergency.
• If not recognized in time and treated on
sound basis of pharmacology and
toxicology of this alcohol, it can lead to
considerable magnitude of morbidity as
well as mortality

4. Why methanol so dangerous?
• The peculiarity of methanol
poisoning is the latent period
between the ingestion of the
alcohol and the appearance of
manifestations.
• The latency may be related to the
concomitant ingestion of ethanol
which affects the metabolism of
methanol
• The symptoms of methanol
poisoning are non-specific except
for the visual disturbances

5. Methanol Metabolism
Methanol
Alcohol dehydrogenase *
Formaldehyde
Alcohol dehydrogenase
Formic Acid
C02 H20

6. Signs & Symptoms
• Ocular changes consisting of
retinal oedema, blurring of the
disc margins, hyperemia of the
discs and optic atrophy as a late
sequlae are quite characteristic
of poisoning.
• The terminal event is often
respiratory arrest. The fatal
period is from 6-36 hours.
• Once the symptoms develop
they progress at an alarmingly
fast rate.

7. Treatment
• Airway, breathing, circulation – ensure adequacy
• 3 primary goals of therapy include treatment of:
• metabolic acidosis: Inj. Sodium bicarbonate I.V. 1 ml/kg should
be administered to correct serum pH
• inhibition of the methanol metabolism: Inj. Ethanol 1 ml/Kg/hr
for non-alcoholics and higher doses for alcoholics. This is usually
not available. Oral Ethanol – 125 ml of Gin, Whisky, or Vodka is an
alternative
• enhanced elimination of the unmetabolized compound and
existing toxic metabolites: Haemodialysis / Folic acid / Antizol
• Treatment of serious cardiovascular and neurological signs, such
as hypotension and seizures.
• Gastric decontamination is UNLIKELY to be beneficial, unless
instituted within 1 hour after ingestion.

8. Treatment contd.
The elimination of methanol may be enhanced by the
following methods:
• Inj. Folic acid 50 mg IV every 4 hours. This is a cofactor in
the conversion of formic acid to carbon dioxide.
• Haemodialysis is recommended when acidosis is not
corrected with Bicarbonate or when optic neuritis is
present.
• Inj. Antizol (Fomepizole) 15 mg/kg bolus, followed by
doses of 10 mg/kg every 12 hours for 4 doses, then 15
mg/kg every 12 hours. All doses should be administered
as a slow intravenous infusion over 30 minutes.
Fomepizole is a relatively recent safe and effective
antidote for ethylene glycol and methanol poisoning.
However, should not be used along with ethanol.

9. Why give alcohol to patient of
alcohol poisoning?
• The reason you can treat methanol
poisoning with ethanol (whisky, gin, vodka
etc.) is that ethanol acts as a competitive
inhibitor. Ethanol is a competing substrate
and so it blocks the conversion of methanol
to its toxic products. Competitive inhibitors
act by occupying the same site in the
enzyme that the substrate occupies thus
preventing the substrate from being acted
upon by the enzyme

10. HOW CAN EMS HELP?
• All scientific reports on
methanol poisoning have
associated high mortality to
the delay in the treatment
• Early activation of MCI protocol
• Choose destination hospitals
with adequate capability
(haemodialysis / beds / ICU)
and competency.
• Single most effective
intervention that can be done
in pre hospital care setup is:
GIVE IV / ORAL ALCOHOL
(ethanol)