Overlawyered: “Batman Begins”: Bruce Wayne, Defendant

Why Batman would be toast today: Overlawyered: "Batman Begins": Bruce Wayne, Defendant.

Funny, the Chief of Police always seemed glad to see him.  Times have changed.

Alcohol poisoning kills 49 Kenyans; Toxic Alcohols strike again

It’s neither for breakfast or drinking: CNN.com – Alcohol poisoning kills 49 Kenyans.

NAIROBI, Kenya (AP) — An illegal brew laced with industrial alcohol caused the deaths of 49 people in Kenya, medical workers said Sunday, while police continued to search for a woman suspected of distributing the drink to local bars.

More than 174 people were hospitalized Saturday and Sunday, after drinking the homemade brew containing methanol — a toxic wood alcohol added to the concoction to give it more kick.

More poisoned patients were still arriving at Machakos General Hospital, medical superintendent Simon Mueke said by telephone.

"Two people have gone completely blind, and another eight have reduced vision of varying degree," he said.

(emphasis added; and, it doesn’t give ‘more kick’, it’s just a cheap, easy and deadly substitute for ethanol)

Toxic alcohols are one of the toxicology problems Emergency Physicians are taught to think about, and to treat if they are found.  Methanol (windshield washer fluid, among other sources) is the prototypical toxic alcohol, followed by ethylene glycol (antifreeze).  The time-honored treatment?  Ethanol.  That’s right, good old booze, tonsil-wash, stupid-juice, hair-of-the-dog, idiot-oil, hooch.  Why?  Glad you asked.

The problem with methanol metabolism and its toxicity has to do with the enzyme, alcohol dehydrogenase (adh-ase).  Or, rather, the lack of ethanol if methanol is around.  Basically, adh-ase very much prefers to metabolize ethanol, and will essentially ignore methanol if there is any ethanol for it to work on.  Enter the Alcohol Treatment.

So, giving the patient a decent buzz (an ethanol level above 0.1, where 0.8 is the limit to drive legally) is a proven, safe way to limit methanol toxicity while other measures are worked on (dialysis, +- folate, etc).  If the patient is a chronic drinker, the trick is just to keep the patient juiced on oral ethanol.  This is problematic, however, and since the adverse event is blindness and deathm it’s to be avoided.

That’s where either IV ethanol or the latest miracle, Fomepazole, comes in.

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