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  • There's A Reason That Drink Is Called 'Gin Bulag' And A Mouthful Can Kill You

    A few drinks of that lambanog can turn out to be something much more serious: Methanol poisoning.
    by Regina Layug Rosero .
There's A Reason That Drink Is Called 'Gin Bulag' And A Mouthful Can Kill You
PHOTO BY iStock
  • You hear about someone who goes to a party and has a few drinks. For some reason, after a day or two, she starts hyperventilating and exhibiting signs of difficult, labored breathing. But her blood pressure is normal, and there is no fever. She’s taken to the emergency room, where she’s treated for breathing problems. She feels better and is sent home. The next day, she is found dead.

    All she had was a few drinks, you think. But it turns out it was something much more serious: Methanol poisoning.

    The case was discussed by Chenery Ann E. Lim, M.D., during her lecture at St. Luke’s Medical Center in Quezon City. Dr. Lim is a Clinical Research Fellow and Ph.D. candidate at the Oslo University Hospital. She also works with Medecins Sans Frontières (MSF), and her work has brought her to missions in Indonesia, South Sudan, Nigeria, Ethiopia, and Sierra Leone.

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    What is methanol?

    According to the Methanol Poisoning initiative (MPi), a partnership between Oslo University Hospital and MSF, “Methanol is a widely available chemical used for many purposes: as a solvent in inks and dyes, in chemical synthesis and as a transportation fuel.” It is tasteless and odorless, and it is easily absorbed by the skin.

    Methanol is present in many items pretty much everywhere, even in your own house. It’s in some lotions and hand sanitizers. It’s used in the process of making the fibreboard in your desks and shelves. It’s in paint thinner, laminated sheeting, and vinyl adhesives.

    And yes, methanol can be in your cocktail glass too. MPi says, “Methanol is added to alcoholic drinks,” usually in the informal or illicit production of alcohol, sort of like an extender, as it is a cheaper substitute for ethanol.Obviously, you’re not going to start consuming lotion or paint thinner, but it helps to be aware of the dangers.

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    Methanol in 'gin bulag' and lambanog

    In China, there was a toddler whose parents accidentally wiped him down with industrial alcohol to bring down his fever, and he died from methanol poisoning. Whether you drink it or put it on your skin, “A mouthful of methanol can kill you,” says Dr. Lim.

    In the Philippines, methanol in alcohol is best known as “gin bulag,” which is actually appropriate, because blindness and blurred vision are distinct features of methanol poisoning.

    The most recent local outbreak in the Philippines, Dr. Lim shared, happened just last Christmas. On December 23 and 24, 2019, 494 people were diagnosed with methanol poisoning, possibly the largest methanol poisoning outbreak last year. There were 14 deaths. Earlier this February, a farmer in Quezon died of methanol poisoning after drinking lambanog.

    Many of the cases involve homemade or locally distilled liquor, but in July 2019, a particular brand of local alcohol dominated headlines: Cosmic Carabao. Two women drank the local gin and were diagnosed with methanol poisoning. One woman died. The other one survived, but she is now blind in her left eye, and there was damage to her right eye as well.

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    Dr. Lim says these incidents are just the tip of the iceberg. “Thousands are being poisoned, blinded or even killed [by methanol poisoning] every year, but cases are rarely reported.”

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    How do we know if it’s methanol poisoning?

    Unfortunately, Dr. Lim says, methanol poisoning is hard to diagnose because it’s “a great imitator; it’s often misdiagnosed as other health issues, like asthma, cardiac problems,” like the case described at the beginning of this article.

    According to MPi, methanol by itself is not toxic, but when you ingest it, the body metabolizes it and that’s when the problem starts. “Methanol is metabolized to a very toxic substance — formic acid. In the absence of ethanol, it takes about 12 to 24 hours to produce enough formate for symptoms of poisoning to appear.”

    Symptoms include hyperventilation and dyspnea or difficult, labored breathing. There’s also pseudopapillitis or swelling of the optic nerve. This can sometimes be seen by a regular ophthalmoscope by looking into the victim´s eyes. This is what leads to blurred vision or even blindness.

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    Someone suffering from methanol poisoning might also experience chest pain, gastrointestinal symptoms like vomiting or stomach pain, and the usual signs of what might be mistaken for a severe hangover.

    A clear sign of a methanol outbreak is when people who have been drinking at the same time and place report the same symptoms, suddenly fall seriously ill, go blind, or die unexpectedly. As Lim says, “Where there is one, there are often many!”

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    How do you test for methanol poisoning?

    Methanol poisoning is hard to diagnose because the symptoms are so vague. But there are developments in the research that will make it a little easier.

    In her work in Oslo, Dr. Lim shared, “We came up with a rapid diagnostic test (RDT) for methanol poisoning, like the malaria RDT.”

    It looks like a pregnancy test, and all you need is a drop of blood to detect the toxic metabolite formate. The test is extremely simple; it needs no laboratory and the result appears within a few minutes. The prototype of the device is now under development, and it will hopefully be available in the market within a couple of years.

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    Dr. Lim is also part of a project where new technology, based on a Gas Chromatography - Ion Mobility Spectrometer, can detect methanol in the breath. This is part of a larger European study, and might also become a solution in the future.

    How do you treat methanol poisoning?

    Anyone with suspected methanol poisoning should go to a hospital immediately, where doctors may treat the condition with buffer, antidote, dialysis and/or ventilator support. The important thing is to get diagnosed correctly as early as possible so that the correct treatment can be administered.

    Dr. Lim emphasizes, “Methanol poisoning can happen to anybody. It’s not a weakness or a moral failing. It is a disease, and treatment works.”

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