Following the deaths of six tourists from suspected poisoning caused by the consumption of counterfeit alcoholic beverages, the United States, in conjunction with other nations, issued a travel advisory last week regarding visits to Laos, particularly the town of Vang Vieng, a popular destination among backpackers, including Israeli travelers.
The consumption of counterfeit alcohol poses significant health risks, including blindness, renal impairment and irreversible neurological damage. Fatalities have been well documented. Medical experts from Rambam Health Care Campus provide an explanation of alcohol poisoning, its pathophysiological effects on the human body, preventive measures and the importance of seeking immediate medical attention upon the onset of symptoms.
According to reports, cases of poisoning among the tourists—two young Australian women, a 28-year-old British woman, and several from Denmark and the United States—were attributed to the ingestion of counterfeit alcoholic beverages containing methanol, a toxic chemical sometimes present in illicitly manufactured alcohol. The concern remains that contaminated alcoholic beverages may still be in circulation in Vang Vieng and its surrounding areas.
Counterfeit alcoholic beverages, such as vodka, brandy, whiskey and others, are often adulterated with high concentrations of methanol, a substance primarily used in industrial applications. In standard alcoholic products, methanol is present in negligible amounts, alongside ethanol, the primary intoxicating component. In counterfeit alcohol, however, the ratio is altered, with methanol being present in dangerously high concentrations to reduce production costs, resulting in a life-threatening product.
Spectrum of risks: Beyond intoxication
Those who consume counterfeit alcohol are at significant risk of developing severe symptoms due to methanol exposure. Potential consequences of ingesting counterfeit alcohol include blindness, irreversible renal damage, permanent neurological impairment and a high mortality rate—even with low levels of consumption.
Methanol primarily exerts its toxic effects on the central nervous system (CNS), but its metabolic breakdown within the body poses additional dangers, accounting for the extensive physiological damage observed in cases of poisoning. The onset of symptoms is typically delayed, appearing several hours after ingestion.
Clinical presentation of methanol poisoning can be nonspecific and challenging to diagnose without laboratory confirmation of the ingested substance. In cases of ethanol-related alcohol poisoning, where excessive quantities of ethanol-containing beverages are consumed, characteristic symptoms are noted alongside elevated blood alcohol concentrations.
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In contrast, methanol poisoning is often characterized by a discrepancy between low blood alcohol levels and clinical features suggestive of intoxication or alcohol poisoning. This discrepancy, coupled with symptoms of renal failure, visual disturbances, or other neurological deficits, raises suspicion of methanol ingestion. However, without laboratory analysis, definitive diagnosis remains elusive.
Clinical manifestations and urgency of intervention
Patients suffering from alcohol poisoning may present with a variety of symptoms, including nausea and vomiting, hypothermia, seizures, altered mental status, loss of consciousness, aggressive behavior, or disorientation, among others.
It is critical to recognize these symptoms and seek immediate medical intervention. Methanol is an exceptionally toxic substance with rapid and profound effects on the body, making early response crucial. Management typically involves pharmacological interventions aimed at inhibiting the enzymatic breakdown of methanol into its toxic metabolites, thereby mitigating its systemic effects. Patients are then closely monitored for complications.
In certain cases, the administration of ethanol may be employed as an antidote, as it competitively inhibits the metabolism of methanol. Alternatively, hemodialysis may be utilized to expedite the removal of methanol and its metabolites from the bloodstream. Treatment decisions are guided by clinical indications and the patient’s overall condition.
- Dr. Assaf Miller is the director of internal intensive care department at Rambam Health Care Campus
- Dr. Yael Loria is the Director of the National Poison Information Center at Rambam Health Care Campus