A To Z of Methanol Poisoning and How Sanitizers Fuel It

As ^sanitizers become the norm of the day in this pandemic world, severe cases poisoning and deaths related to sanitizers are surfacing.

Many were comatose, and those who were conscious had bouts of nausea, vomiting, and hyperventilation. Scarier still, some experienced kidney failure and vision problems. According to a National Geographic report, that’s how the severe the problem is

Methanol Poisoning

When these patients began trickling into emergency rooms at hospitals across Iran in late February, doctors struggled to make sense of what was happening. But Hossein Hassanian-Moghaddam, a clinical toxicologist at Loghman Hakim Hospital in Tehran, had seen this before. Even as cases of the novel coronavirus tore through Iran, a second epidemic emerged in its shadow. By mid-March, an outbreak of methanol poisoning gripped the country.

How deadly rumors can be?

As the coronavirus began to spread throughout Iran, so did a false rumor that drinking high-proof alcohol would kill the virus in the body began circulating. Desperate to protect their families, even those who normally disavowed intoxication started searching for ethanol, the typical ingredient in consumable alcohol. Strained supply chains dovetailed with the opportunity to make a quick buck, and Iran quickly found itself awash in poisonous booze.

It would become the largest—and deadliest—such event doctors had recorded, garnering 5,876 hospitalizations and at least 800 deaths between February 23 and May 2.

Hassanian-Moghaddam says that even young children began showing up in hospitals with methanol poisoning, having been given contaminated alcohol by their worried parents in the hopes that it would prevent the coronavirus.

In the United States, these incidents are automatically listed as binge drinking or alcohol poisoning. They don’t try and decipher if it’s methanol.

“Methanol poisoning is an extremely under-recognized problem,” Hovda says, “and we also know that just a fraction of those ever get diagnosed.”

Cheap alcohols fueling this?

Soon, countries from Mexico to the Dominican Republic to the United States would all find themselves confronting methanol poisoning. Methanol, also known as wood alcohol, is used as an industrial solvent. Because it’s so cheap and mimics the properties of ethanol, unscrupulous manufacturers will often dilute costlier alcohols with methanol. The problem is most common in countries with lax regulations or those dependent on black market booze. Disruptions from COVID-19 have made adulterated ethanol even more common, which has led to a spike in methanol poisoning, both in bottom-shelf liquor and in products like hand sanitizer.

“Many of the alcohols on the market were contaminated,” Hassanian-Moghaddam says of the situation in Iran, “and there was no shortage of people eager to buy cheap alcohol.”

Methanol and ethanol are chemical kissing cousins. Whereas ethanol has two carbon atoms, methanol only has one. Both are clear liquids that can quickly evaporate, and they taste similar too. Drink them, however, and the similarity ends.

Toss back a shot of high-proof ethanol, and most people get a pleasant buzz. Toss back an equivalent shot of methanol, and you could be dead by morning. Less than a tablespoon of pure methanol (10 milliliters) can kill you.

The liver uses enzymes, including one called alcohol dehydrogenase, to transform ethanol from a mild toxin into a harmless chemical called acetate. The liver also uses alcohol dehydrogenase to break down methanol—and that’s where the problems start.

Instead of becoming a harmless chemical building block, the body metabolizes methanol into toxic formic acid.

Formic acid interferes with a cell’s ability to make energy. Over time, it can starve cells of the oxygen and energy they need, which is a major problem for power-hungry optic nerves, leaving many methanol poisoning victims with permanent blindness.

The breakdown of methanol also creates an imbalance in the tightly regulated levels of acids and bases in the body, explains Frank Edwards, an emergency room physician at Arnot Ogden Medical Center in Elmira, New York.

“In a case of methanol poisoning, that imbalance is created by the buildup of formic acid,” he says.

Difficult To diagnose methanol poisoning?

Although basic blood tests can often provide clues to methanol poisoning, making the diagnosis isn’t easy.

Most contaminated alcohol is a mixture of methanol and ethanol, and alcohol dehydrogenase will break down all the ethanol in the body before it starts in on the methanol.

Depending on how much ethanol a person has been drinking, it can take several days for someone to begin experiencing symptoms of methanol poisoning.

Thus, an individual may not connect the dots between their current symptoms and their previous drinking, nor do physicians always figure it out, says Kemal Canlar, founder of SafeProof.org.

How to treat it?

A prescription drug called fomepizole binds to alcohol dehydrogenase and prevents it from turning methanol into formic acid.

If fomepizole isn’t available, doctors can treat methanol poisoning with ethanol itself.

Both strategies allow the body to excrete the methanol before it’s turned into formic acid.

Ethanol not an antidote for methanol poisoning

The idea that ethanol is a leading antidote for methanol poisoning is not only ironic, it’s also used as a justification for the adulteration by dishonest manufacturers, Canlar says.

The bootleggers feel that as long as they leave some ethanol, it will neutralize the deleterious effects of the methanol. Others simply don’t know that methanol is toxic—or just don’t care, he says.

The Demography of .ethanol poisoning?

Even though the phenomenon is much rarer in America than in other countries due to more stringent regulations on alcohol sales and distribution, those impacted in the U.S. by methanol poisoning tend to also be disproportionately poor and from minority groups, says Susan Smolinske, director of the New Mexico Poison and Drug Information Center.

That’s what Smolinske found this May, when she received a call from her colleague Steve Dudley of the Arizona Poison and Drug Information Center in Phoenix, Arizona. Brooks had received reports from emergency room physicians across Arizona that a handful of people, mostly men in their 30s and 40s, had shown up at hospitals with methanol poisoning.

After conducting a similar investigation in New Mexico, Smolinske, Brooks, and a team of epidemiologists from the Centers for Disease Control and Prevention identified 15 cases of methanol poisoning across the two states between May 1 and June 30.

Four of these individuals died, and three were left with permanent visual impairments.

In July, Smolinske says, four more people were hospitalized in New Mexico.

The U.S. Food and Drug Administration has since issued warnings about a variety of hand sanitizer products due to contamination issues.

Smolinske adds that the danger is primarily through the oral consumption of these sanitizers, given that skin exposure probably isn’t enough to cause major problems.

“Even with 100 percent methanol, it would take about six hours of complete immersion—like submerged—to get to a toxic methanol level,” Smolinske says, citing a 1980 study that measured how quickly methanol was absorbed through the skin.

But use of the contaminated sanitizer could still lead to nausea, vomiting, and vision problems—not to mention that methanol is ineffective at killing microbes.