Toxicology : What a common man should know about it?
We live in a world of poisons; we breathe poisonous air; we drink poisonous water; we eat poisonous food; we live with poisonous plants and animals around us. Even the mother earth is impregnated with poisons. In spite of these handicaps our life goes on, because, we have knowledge about poisons, about toxicology. But how knowledgeable are we? Or how knowledgeable a common man is?
Hooch tragedies have become a common occurrence during festive seasons. The poor folks, especially men and women from labour community consume illicit brew contaminated with methyl alcohol (also known as wood alcohol) and get into problems ranging from losing their eye sight to death. Every time such a tragedy occurs I come out with statements through media to say “Buy Indian Made Foreign Liquor (IMFL), whisky, brandy or rum and mix with equal quantity of water and give them to the affected people in small doses at intervals of twenty minutes until they are eventually shifted to hospitals.” I used to tell the same thing to doctors when they ask for antidotes for methyl alcohol poisoning. I repeated the same advice recently when more than 180 people have died in May, 2008 in Bangalore suburbs, Kolar district in Karnataka and neighbouring Tamil Nadu's Krishnagiri district after consuming spurious liquor. Many including the medicos used to think that I am joking. No! This is toxicology put in common man’s perspective
Specific antidote for methyl alcohol poisoning is ethanol and this should be given immediately intravenously (IV) as a 10% solution in 5% dextrose. This protocol is possible only in a hospital. But the patients always reach the hospitals after lapse of the initial crucial hours for treatment. Even in hospitals ethanol is not stored for free availability. The Indian made liquors mentioned above contains 42.8 percent of ethyl alcohol volume by volume and if diluted with equal amount of water, they will contain about 20 percent of ethyl alcohol. This is the recommended dose if administered orally. The patient also will happily drink this concoction. It is only because they cannot afford to buy these licit liquors they had gone for illicit liquor.
The toxicology behind this treatment is this: Many substances regarded as poisons are toxic only indirectly and methanol is one among such substances. Methanol if ingested is metabolized by alcohol dehydrogenase to formaldehyde, which is itself rapidly oxidized to the principle toxin, formic acid in the liver. It is the formaldehyde and formic acid that cause the toxic effects. This metabolization is inhibited in the presence of ethanol. Significant ingestion of methanol causes nausea, vomiting and abdominal pain. Its effects on the CNS resemble those of ethanol although in low doses it does not have an euphoric effect. Ingestion of only 10ml of methyl alcohol can cause blindness and 30ml can result in death. Administration of diluted alcoholic beverage in such situations will not only save the life of hooch victim but his eye-sight as well.
Well then! Is alcohol not a poison? Alcohol, of all the materials correctly classified as poisons, is probably responsible for more deaths by direct toxic action than any other poison, and possibly far more than caused by all other poisons together. Death from alcoholic poisoning can occur at blood levels in excess of about 300mg/100ml. It is common experience that the intoxicating effects produced by alcoholic beverages vary from individual to individual; even with the same person, variations in the effects of alcohol are experienced at different times. Women are usually more affected at lower levels, though the world record for survival was a woman who survived a blood alcohol of 1100 mg/100 ml. Many drivers arrested in Australia had blood levels over 500 mg/ 100ml.
The general spectrum of behavior in terms of milligrams of alcohol per 100 milliliters of blood is interesting. At lower levels, within 100mg/100ml limit, the behavior level is described as dry and decent. If an average ‘75 kg man’ drinks ‘one large’ i.e. 2 oz (60 ml) of 75 proof whisky (IMFL) or one large bottle of beer, his blood alcohol level reaches 40 mg/100ml. Then his behavior level is described as ‘dry and decent’. The individual may describe the feeling as a “glow or a feeling of well being. He will be relieved of his inhibitions. It is on this basis, the saying ‘one for the road’ came into vogue among truck drivers. The truck drivers ‘one’ means one large peg of a high ball. (60 ml of 100 proof whisky) which is within the permitted level of blood alcohol. In England it is 80mg/100ml. I may cite here an interesting case of an alleged drunken police constable served as an orderly in the house of a police officer. He was accused of misbehavior in the officer’s house and his blood and urine were sent to my lab for alcohol estimation. My assistant after analysis brought to me the results which showed 800 mg /100ml in blood and a1600mg/100ml in urine. For this result police constable should have already died. But my assistant said he is waiting to collect the result. I asked my assistant to give the report as “the alcohol levels found in the blood and urine are not in consonant with the levels expected from the specimen of a drunken man who is still alive. The specimen do not contain ingested alcohol but added alcohol” > it is a different story that the officer was in soup and not the constable.
We live in a world of poisons; we breathe poisonous air; we drink poisonous water; we eat poisonous food; we live with poisonous plants and animals around us. Even the mother earth is impregnated with poisons. In spite of these handicaps our life goes on, because, we have knowledge about poisons, about toxicology. But how knowledgeable are we? Or how knowledgeable a common man is?
Hooch tragedies have become a common occurrence during festive seasons. The poor folks, especially men and women from labour community consume illicit brew contaminated with methyl alcohol (also known as wood alcohol) and get into problems ranging from losing their eye sight to death. Every time such a tragedy occurs I come out with statements through media to say “Buy Indian Made Foreign Liquor (IMFL), whisky, brandy or rum and mix with equal quantity of water and give them to the affected people in small doses at intervals of twenty minutes until they are eventually shifted to hospitals.” I used to tell the same thing to doctors when they ask for antidotes for methyl alcohol poisoning. I repeated the same advice recently when more than 180 people have died in May, 2008 in Bangalore suburbs, Kolar district in Karnataka and neighbouring Tamil Nadu's Krishnagiri district after consuming spurious liquor. Many including the medicos used to think that I am joking. No! This is toxicology put in common man’s perspective
Specific antidote for methyl alcohol poisoning is ethanol and this should be given immediately intravenously (IV) as a 10% solution in 5% dextrose. This protocol is possible only in a hospital. But the patients always reach the hospitals after lapse of the initial crucial hours for treatment. Even in hospitals ethanol is not stored for free availability. The Indian made liquors mentioned above contains 42.8 percent of ethyl alcohol volume by volume and if diluted with equal amount of water, they will contain about 20 percent of ethyl alcohol. This is the recommended dose if administered orally. The patient also will happily drink this concoction. It is only because they cannot afford to buy these licit liquors they had gone for illicit liquor.
The toxicology behind this treatment is this: Many substances regarded as poisons are toxic only indirectly and methanol is one among such substances. Methanol if ingested is metabolized by alcohol dehydrogenase to formaldehyde, which is itself rapidly oxidized to the principle toxin, formic acid in the liver. It is the formaldehyde and formic acid that cause the toxic effects. This metabolization is inhibited in the presence of ethanol. Significant ingestion of methanol causes nausea, vomiting and abdominal pain. Its effects on the CNS resemble those of ethanol although in low doses it does not have an euphoric effect. Ingestion of only 10ml of methyl alcohol can cause blindness and 30ml can result in death. Administration of diluted alcoholic beverage in such situations will not only save the life of hooch victim but his eye-sight as well.
Well then! Is alcohol not a poison? Alcohol, of all the materials correctly classified as poisons, is probably responsible for more deaths by direct toxic action than any other poison, and possibly far more than caused by all other poisons together. Death from alcoholic poisoning can occur at blood levels in excess of about 300mg/100ml. It is common experience that the intoxicating effects produced by alcoholic beverages vary from individual to individual; even with the same person, variations in the effects of alcohol are experienced at different times. Women are usually more affected at lower levels, though the world record for survival was a woman who survived a blood alcohol of 1100 mg/100 ml. Many drivers arrested in Australia had blood levels over 500 mg/ 100ml.
The general spectrum of behavior in terms of milligrams of alcohol per 100 milliliters of blood is interesting. At lower levels, within 100mg/100ml limit, the behavior level is described as dry and decent. If an average ‘75 kg man’ drinks ‘one large’ i.e. 2 oz (60 ml) of 75 proof whisky (IMFL) or one large bottle of beer, his blood alcohol level reaches 40 mg/100ml. Then his behavior level is described as ‘dry and decent’. The individual may describe the feeling as a “glow or a feeling of well being. He will be relieved of his inhibitions. It is on this basis, the saying ‘one for the road’ came into vogue among truck drivers. The truck drivers ‘one’ means one large peg of a high ball. (60 ml of 100 proof whisky) which is within the permitted level of blood alcohol. In England it is 80mg/100ml. I may cite here an interesting case of an alleged drunken police constable served as an orderly in the house of a police officer. He was accused of misbehavior in the officer’s house and his blood and urine were sent to my lab for alcohol estimation. My assistant after analysis brought to me the results which showed 800 mg /100ml in blood and a1600mg/100ml in urine. For this result police constable should have already died. But my assistant said he is waiting to collect the result. I asked my assistant to give the report as “the alcohol levels found in the blood and urine are not in consonant with the levels expected from the specimen of a drunken man who is still alive. The specimen do not contain ingested alcohol but added alcohol” > it is a different story that the officer was in soup and not the constable.
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