Methanol in fake alcoholic beverages B. Salahshour et al. ORIGINAL ARTICLE ORIGINAL ARTICLE Analysis of methanol content in fake alcoholic beverages during a methanol mass poisoning outbreak (Bojnourd- Northeast of Iran, 2018) BABAK SALAHSHOUR1, SAJJAD SADEGHI1,2, KAMBIZ SOLTANINEJAD1* 1 Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran 2Legal Medicine Center of North Khorasan Province, Bojnourd, Iran Abstract Background: Consumption of non-commercial alcoholic drinks is the main cause of methanol poisoning in the world. Non- standardized production methods or deliberate spiking of methanol in non-commercial and homemade alcoholic beverages have been reported, globally. The analysis of toxic alcohol contents in illegally produced alcohol beverages is necessary for prevention and early diagnosis of methanol poisoning especially during alcohol mass poisoning episodes. In this study, we analyzed methanol, ethanol and higher alcohols content in seized illegal alcoholic beverages during methanol mass poisoning outbreak in Bojnourd City (northeast of Iran) in 2018. Method: During the methanol mass poisoning outbreak in Bojnourd city (northeast of Iran), happened in one –month period from September 22 to October 22, 2018, samples of all illegal alcoholic beverages either found consumed by poisoned patients who admitted to the hospitals or seized by the law enforcement were analyzed. Qualitative and quantitative analysis of ethanol, methanol, 1-propanol, 2-propanol and acetone were performed using GC-FID method. Results: In the samples collected from a total of 116 seized illegally produced alcohol beverages; methanol was detected in 39.6% with mean concentration of 77.6 %v/v and the range from 12 to 97% v/v. Ethanol was detected in 77 (66.4%) samples with mean concentration of 32.3%v/v. Only 8 (6.9%) samples had a mixture of ethanol and methanol. 1-propanol, 2-propanol and acetone were not detected in any samples. Conclusion: Methanol is the main toxic chemical component in illegal alcoholic beverages with toxic level and could be considered as a cause of mass poisoning during the alcohol mass poisoning in Bojnourd City. This finding could be considered in planning and implementing of public health measures in Iran. Keywords: Methanol; Alcoholic beverages; Poisoning; Epidemiology How to cite this article: : Salahshour B, Sadeghi S, Soltaninejad K. Analysis of methanol content in fake alcoholic beverages during a methanol mass poisoning outbreak (Bojnourd- Northeast of Iran, 2018) . Asia Pac J Med Toxicol 2020; 9(4):142-149. enzymes during the production of non- commercial alcoholic INTRODUCTION drinks using non-standard and home-made procedures (3-5). Methanol (methyl alcohol, wood alcohol, wood spirit, Methanol may also be found in distilled alcoholic CH3OH) is a volatile, flammable, colorless and toxic liquid, beverages as a contaminant especially during illegal and poor produced from distillation of destructed cellulose materials quality control production conditions however the source of and it may be found in antifreeze products, solvents and the methanol in these types of alcoholic drinks is unclear engine fuel (1,2). Also, methanol may be detected as a (3,4,6). Methanol has been illegally used in the production of contaminant in alcoholic beverages (3,4). cheap and counterfeit alcoholic beverages. Some profiteers During the fermentation process for production of the might have deliberately spiked the beverages with methanol alcoholic beverages, methanol may be produced in low or use it instead of ethanol because of its lower price and its concentrations (3). Methanol contamination in traditionally availability (7). fermented alcoholic drinks is an increasing problem resulting Methanol poisoning is one of the main causes of morbidity in poisoning of consumers (3-5). The origins of methanol in and mortality as a result of consumption of unrecorded fermented alcoholic drinks have not been clearly established. especially counterfeit alcoholic beverages all over the world It is likely that the methanol might have been produced due and it continues to be a serious health concern in many to fermentation of pectin and sugars by microorganisms countries (2,8). Methanol converts to toxic metabolites including yeast, bacteria and fungi containing pectolytic including formaldehyde and formic acid via hepatic alcohol ________ _______ *Correspondence to: Dr. Kambiz Soltaninejad, Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Behesht Street, Tehran-1114795113, Iran Tel: +98-21-55613731, E-mail: [email protected] 142 ASIA PACIFIC JOURNAL of MEDICAL TOXICOLOGY APJMT 9;4 http://apjmt.mums.ac.ir December 2020 dehydrogenase and aldehyde dehydrogenase, respectively. 2-propanol and acetone were accomplished using an Nickel These metabolites cause the toxic presentations such as tubing GC packed column (2.0 m, L× 1/8” × 2.0 mm, ID), severe metabolic acidosis, optic neuropathy, cerebral edema packed with Porapak Q, 80/100 mesh, pre-conditioned and acute renal failure (9). Several major methanol mass (Agilent, USA). Briefly, the GC-FID parameters were as poisoning outbreaks in developing countries with high follows: carrier gas: nitrogen (flow rate: 20 mL/min); Zero air morbidity and mortality have been reported (1,7-10). with hydrogen gas as combustion gas; Injector temperature Production of the illegal alcoholic drinks for economic was 150ºC, detector temperature was 300ºC and column benefits remains as a common problem, globally. In addition, temperature was 140ºC. The signals and data acquisition in the Islamic countries like Iran, production, distribution, system are processed by a software package (Chem Station ®, sale and consumption of the alcoholic beverages is prohibited Agilent, USA). This method has been validated previously and considered a criminal act according to the legal and and used as a routine analytical method for determining religious rules (7,11). Nevertheless, in these countries the alcohols and related compounds according to the Standard production of illegal alcoholic beverages is common (5,7). Operating Procedure (SOP) manual in our laboratory. Although, the methanol mass poisoning outbreak due to The quantitative analysis of the target compounds was drinking of the illegal and non-standard alcoholic products carried out following calibration of the GC-FID system. The have been reported, worldwide, there are scant data available calibration curves were obtained by injections of 1 ml of the about analysis of methanol content in consumed counterfeit standard mixtures containing individual target compounds at alcoholic beverages (7,12). concentrations of 0.1,0.2, 0.4, 0.6, 0.8, and 1 volumetric In this study, we aimed to analyze methanol, ethanol and percentage (v/v%) The concentrations of analytes in volu me other toxic alcohols contents in seized unrecorded alcoholic –volume percent (v/v %) were calculated by the data analysis beverages consumed by victims during a methanol mass software according to the calibration curves. poisoning outbreak. Data were analyzing using Statistical Package for the Social Sciences (SPSS) software (SPSS Inc, Chicago) version METHODS 20. Sample and data collection In a cross-sectional study, during the methanol mass RESULTS poisoning outbreak in Bojnourd city (northeast of Iran), During the methanol mass poisoning outbreak, a total of happened in one- month period from September 22 to October 74 patients were hospitalized over the period of 31 days. 22, 2018, samples of all submitted illegal alcoholic beverages Sixty-nine (93.2%) of them were males with a mean age of either consumed by poisoned patients who admitted to the 31 years (range: 15-61 years old). From the total of 74 hospitals or seized by the law enforcement from the dealers, patients, 8 were deceased, which made the overall mortality to the Forensic Toxicology Laboratory of the Legal Medicine rate of 10.8%. Patients were treated with bicarbonate Center (Bojnourd -Iran), have been analyzed. Also, the (94.5%), ethanol (100%), hemodialysis (14.8%), and demographic and clinical outcomes of the patients were mechanical ventilation (13.5%) based on their clinical obtained from hospitals authorities. presentations and blood gases. Out of the 66 patients who survived, two patients (3%) had developed toxic optic Chemicals neuropathy, and one patient (1.5%) blindness. The rest of the Methanol, ethanol, 1-propanol, 2-propanol and acetone survived patients discharged without any long-term were purchased from Merck Co. (Darmstadt, Germany) and complications. used as standards for qualitative and quantitative analysis of From total of 116 samples that analyzed during the the samples. Double distilled water was purchased from outbreak period, 46 alcoholic beverage samples obtained Merck- Millipore. All chemicals were of high performance from poisoned patients and the rest of them were from the liquid chromatography grade. alcoholic drinks seized by the law enforcement from the dealers. The organoleptic evaluation results are shown in Sample preparation Table 1. The results showed that most of the samples were Samples were decanted into a volumetric flask and packaged in plastic bottles (86.2%), with volume range organoleptic examinations (including: appearance, volume, between 20- 1500 mL. The pH range of samples was 3.6 - 4 odor, color, pH (pH meter, Methrom, Switzerland), labeling (44.7%). Most of the samples (67.3%) had