Medical aspects of illicit brews

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BY DR SIMON ONSONGO AND PROF PETER OJWANG

In the recent past many Kenyans have lost their dear lives to illicit brews that have now come to be common phenomenon in this country.

Despite the spirited effort by the law enforcement agencies, many Kenyans still continue to suffer from the direct and indirect complications of illicit brews in various parts of the country.

Some of these brews which go by their traditional names include busaa, changáa, mnazi, kalovo and muratina.

The drinks are readily available in many places in Kenya but more prevalent in the low socio- economic areas where most people cannot afford to buy the commercially prepared drinks available in the market.

Some of the traders who sell these illicit brews lace them with compounds like methanol to make them more potent and to increase their sales volumes.

Methanol is the preferred agent in most cases because it is cheap, readily available in most places and has a similar taste with alcohol hence it is undetectable to the unsuspecting public. So how do these illicit brews lead to the various medical complications associated with them?

Medical complications following consumption of illicit brews commonly arise from the toxic effects of methanol. In its pure form, methanol is a colourless volatile liquid at room temperature with a faint alcoholic smell.

It is readily miscible with water. It has wide applications mainly as an industrial chemical in the synthesis of many substances e.g. dyes, paints, printing and photocopying agents, varnishes, wind shield washer fluid and paint removers.

It is also used in denaturation of ethanol used for industrial uses. Denaturation is a process  of adding additives to ethanol to make it poisonous or unpalatable. Denatured alcohol also called methylated spirit attracts less tax hence is cheaper than pure ethanol.

Ingestion of methanol can be unintentional like in unsuspecting alcoholic taking illicit brews laced with methanol or by children who may accidentally ingest the compound.

People who want to commit suicide may also intentionally drink methanol. Rare cases of poisoning have been reported in industries due to prolonged inhalation of methanol fumes or prolonged skin contact especially in industries.

Lethal doses of methanol vary from individual to individual but usually range from as small as 60mls to 500mls of pure solution. It is almost impossible to determine the exact amount of methanol in an individual who has taken illicit brews.

Once ingested, methanol is rapidly absorbed from the gastrointestinal tract usually within 30 minutes but can take up to one hour in individuals who have eaten prior to ingestion. It is worth noting that methanol is metabolised to form toxic metabolites once absorption has occurred from the gut.

The liver is the major site of conversion of methanol to its toxic metabolite, formic acid which is responsible for the various toxic effects seen in poisoned victims. This toxic metabolite takes approximately 20 hours to be eliminated in the urine but this to a great extent depends on the amount of methanol ingested.

The formic acid acts by inhibiting tissue respiration in many tissues but the optic nerve, which is important for vision and the brain are the most affected.

People with toxicity will have symptoms of blindness, some of the affected people might think that the lights have been switched off. Other symptoms may include vomiting, abdominal pain, vomiting, confusion, rigidity, convulsion, altered speech irregular or fast breathing or may even be unconscious in severe cases. A high index of suspicion is critical in the diagnosis of most poisoned people. 

Once suspected, an individual must be rushed to a medical facility as soon as possible. In the hospital the main principle of managing poisoned people is to try to reduce the absorption from the gut as much as possible and to reduce the formation of formic acid in the liver.

When found early enough within the first 30 minutes efforts to reduce absorption of methanol for the intestines can be instituted.
There are two main antidotes available in cases of methanol poisoning. One is to give the poisoned patient ethanol either given via the veins or orally.

Ethanol should be readily administered in victims as soon as possible to avert the various complications but needs close monitoring in a good hospital set up to avert various complications associated with ethanol itself.

Ethanol acts by reducing the formation of toxic metabolites from methanol. Remember that an excessive amount of ethanol in circulation is also toxic and may cause damage in various body organs.

The second option is a drug called fomepizole which is better than ethanol but is more expensive and not readily available in most places.  For those poisoned people who may take a long time to reach a health facility, taking any ethanol formulation maybe the only way to prevent blindness or stop death.

Other types of alcohols that can cause poisoning include ethylene glycol, diethylene glycol and isopropanol but are rare causes of poisoning in Kenya.

Points to remember about methanol poisoning;

1.Methanol is a toxic compound closely related to ethanol.
2.Methanol is readily available and is  fairly cheap industrial product used in the synthesis of many products.
3.Methanol poisoning can be intentional or accidental and can lead to severe complications.
4.Early suspicion of poisoning and early treatment with ethanol or fomepizole may be lifesaving
5.Fomepizole is a better drug in treating methanol poisoning but is not readily available and is expensive.
6.In persons with suspected poisoning, giving the victim any ethanol formulation may  avert serious complications especially when health facilities are distant.

(Dr Simon Onsongo and Prof Peter Ojwang work at the Department of Pathology, Aga khan University Hospital Nairobi)
 

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  • Prince

    I bought my girlfriend a huge bouquet of flowers and had it delivered to her office. Later took her out for lunch where she poured out her undying love for me. throughout the day she kept calling and texting me telling me how special I am in her life. In the evening she held me close and kissed, she told me she was ready to move in with me and be my wife. We made long passionate memorable love for over 3 hours then she tld me SHE LOVES ME. That was special for me. Her Name is Shiro 0737352891   

  • Zajode

    My wife Emma 0724626026. Shes gonna give me a second born! and she lost the other second born last year. I just want her to be haoppy!

  • Nafula Wekesa

    a colleague at work gave me two tickets for a play. I went with my hubby and we had some lovely time watching ‘Taming the Shrew’ yester-evening at the Professional Centre along Parliament road. Then proceeded home to a lovely evening. It was the much that we can afford looking at the times. he is a wonderful man who works with what he gets and does not promise heaven to deliver earth, he is very realistic and very down to earth. right now, his phone is giving him a hard time like losing the network, battery has issues from here to timbuktu, earpiece decides to die during those critical phone calls, hangs more often than not, overheats….and the list is endless. He is really in need of a change…soon.

  • Samsonkipsang

    I nominate mercy korir.she is the first chick to celebrate Valentine’s in my life.usually @this period am encountering disagreements bt not this time. I took her to a spa and showered her all my love. Bought her red roses and wot I loved most was her sincerity.love u Mercy. I won’t forget it despite the calculation 14-02-12=0

  • Terilmicks

    My boyfriend gave me roses, chocolates and wine with a card saying ” We need you back to health soonest so we can indulge in these.” It was a very sweet gesture because i had been sick for the past two months and had no appetite for anything at all. But yesterday i actually ate without any problems and wasnt I happy. I even feel like i have fully recovered.

  • Valerie Waweru

    i have always been a believer in small but meaningful gifts. My boyfriend captured the essence of that yesterday.
    from midnight yesterday he sent me am sms each hour , never late reminding me of how we meet, the challenges we have had, the good times and hopes for the future. i did not get to see him but i was with him all day 🙂 He should get a phone to send me more messages 🙂

  • Victor

    i nominate Precious Limie for Sacrificing her time just to be with me Victor Odhiambo..I miss her already and love  her so much..

  • Mbetemuva

    I was sure this time round I was not getting any gift because he claims that he does not believe in Valentines day. With this in mind I went to school as usual attended my classes and later got a phone call.This was from him and he asked me to meet up with him outside Ukwala Ronald Ngala. I found this awkward but considering the fact that it is valentines ,I was willing to do anything for a gift. I got there and waited for an hour.I got impatient and decided to leave mad at him. When I was just about to leave he came and led me to a nearby restaurant. While at it all I was doing was insulting him for treating me badly and all he could do was nod his head. When we took our seats 4 gentlemen came one of them carrying a guitar and you can guess on what happened. They sang my favorite song and all I could do was cry. Immediately after that he gave me a hug and wished me happy valentines. His name is Ken 0736236860

  • Brendah Brown

    this valentines was definitely a memorable one. you think everything is so perfect only for the world to prove you wrong. I had waited for this valentine so eagerly! I was dating this guy for almost months. I had shopped for clothes for that day,new hair-do,manicured nails,pedicured feet,new shoes..i had gone the whole 10miles for this day. Going to sleep the previous night,i couldn’t help thinking of how awesome it would be and unforgettable. Unforgettable indeed! I woke up that morning and started preparing to meet up with my dude. i wanted enough time and we had agreed we would meet at 11am. then i got a text from him…i was so excited thinking of how i would be showered with romantic sweet words. i could have sworn i pounced on that phone like it would disappear if i did not. “hey, i don’t think us is working”…the text said. i was so heartbroken and furious and the dude switched his phone off. Having given up trying to get an explanation,i lay on my bed with pretty clothes thinking how disastrous this valentines was turning out to be. i thought i was done for…it was the worst day ever!! then my best-friend called and told me to meet her at some joint in langata. i went there and found her with another friend of mine. they had apparently had about the news and how it happened, they bought me chocolates and gifts which were mostly jewellery. they tried to cheer me up by making jokes and all. then the waiter brings a bouquet of flowers for all of us and complimentary gifts. we had lunch followed by drinks and lots of laughter. we went to various other joints and we had fun just the 3 of us. and as the day ended i could not help but think of how greatful i am to have my 2 friends..my true friends! they made that day what it was supposed to be…special and filled with fun and most importantly LOVE. they are just like my sisters. i love them so much and i owe it all to them and specifically JOAN 0726705029

  • Sospeter Litala

    I nominate my girlfriend Janet Kuthea; she sacrificed her time out of school despite having tight schedules with C.A.Ts in campo. Initially I was uncertain on whether we’ll really hook up on Valentine Day but she surprised me when she turned out for the day. We had mad fun.

  • ndach everlyn

    this valentines i had waited for it for so long counting days and hours. on that day i went and met my boyfriend. i was broke and so was he so we decided that we would make the time count for memories are much more precious than gifts. i went to his place and he plucked a flower from the road and gave me. it was so romantic. i understood because of the hard economic times. we then went to some kiosk near his place (kwa mama katinda). we ordered all we could buy since food here is really really cheap. there was chapati, rice, mukimo, madondo and ofcourse meat. it wasnt much but we made the most of it. we ate till we could not go on and he kept telling me how much he loves me. he showered me with kisses and after that we bought one bottle of kenya kane which we would not buy on any other day. we went home, drunk alittle and slept as we reflected on how sweet and memorable this valentines was. all thanx to my boyfriend Benna 0723164740

  • Elijahgathanga

    14th February was to be a very lonely day…but OMG she came or rather if I may say Julia Wanjiku my sweethoney pie “tokelezead” n she had an…ayayayayaya plan!Kwanza we headed to Kenyatta National Hospital and visited the sick n homeless,then we hired a cab destination Naivasha!There we had fun at Crayfish and sincerely that is truely Vegas only if you go there is when you’ll know what happens there!She hurriedly shifted gears destination Nairobi National Park for the party in the Wild occasion!Ever been wild in the wild?You missed it fair n square if u weren’t there I tell you!Buffet,music(I mean classic music)meat,meat,n meat kept coming as the day sunk!at 11pm we were in a cab again heading to our house and need I say anything more…Julia Wanjiku made Elijah Ndiritu’s Valentine Day a memorable one and one not to be forgotten [email protected] 0715720033

  • Kevohm

    I nominate my darling Christine: 
    I left work at 10pm Valentines eve and passed via City Market where I got her a bouquet of red roses.
    These she didn’t see till Valentines day as she prepared to leave for work (I hid them in the spare bedroom wishing to surprise her)
    To ma utter surprise, I knocked off a tin of Jean Paul (La Male) “TERRIBLE MEN” as I crumpled to get to the loo….happy valentines it was…..lunch at Cafe Pronto and my best meal was prepared for valentines dinner.

    She should get a phone for making my best valentines ever..

    KEVIN

  • Anonymous

    The mother of my son ‘Mariah’ dropped her phone just a day to Valentine’s day, I had planned to send here a very romantic messages all day through since we were to be confined in our offices day long. I felt so much isolated from her.

    I composed all the messages that i was to sent to her during the day, saved them as drafts. Then came in the evening, I bought some nice roses for here. I have her my phone so that she could read all the draft messages that i had composed for her. She felt happy but she could have felt better if she had her own phone. She needs that phone for us to connect all day long. reach her through my digits 0725206006.

  • Philipkithome

    i didn’t have a
    Valentine coz she left 3weeks to the valentines day but I am tempeted to nominate my lecturer Madam Bett B who kept us occupied with lectures from 8am-5pm then afterwards i caught up with Joy andSoulo in my favourite show(hits not homework)where life is never that serious, all
    about having fun!Day well spent,isnt it?0716794826

  • Aquinas

    She called me on 12th February and told me she had booked me a seat on a Transline Classic Bus to Nairobi. I went and picked my ticket on 13th and found out she had booked me for the night Journey. I travelled to Nairobi and arrived at 2am on 14th February only to find her with a taxi waiting for me. She is a student by the way. We went to Buru Buru where she had booked a double room, I don’t know why. In the morning we had a shower and took breakfast and left for town. We spent the whole day at August 7th Memorial Park the whole day just eating a 4kg cake she had bought and some wine. In the evening she told me she had skived 6 lectures of the day to be with me and handed me a ticket back home. I dropped tears and said if all ladies were like her then the world would be a lovely place to be. She had saved since November Last year for this treat. I love her but I guess she loves me most.

    • Aquinas

      Her name is Lilian Monyenye of phone number 0700221014

    • Philip Ontonyi

      This is awesome

  • I nominate my sister PETRA BOCKLE…14th Feb being valentines day .She has no phone,i pity her because she has tried to fix her phone but to no avail…on that day despite her not having a phone,she took me for ice cream and popcorn …she really made my day day worth and i want her to get that phone as a token of appreciation from me and thanks to Fanta i know i will get it……##No matter how small my description is ..and how short my 14th was…i know being single on 14th is one devastating feeling,and i thank GOD for giving me a sis who made it worthwhile.:-))

  • Jorlo10

    We did not enjoy, i was broke. why lie?.period

  • Ruthabuodha

    my  son  jesse,  on  valentine  day  my  son who  is   six  years  old (class two)  did  something  unusual.  He  picked  his  younger  brother  from  kindergarten  and  saved  him  with  snack  as  they  wait  for  us.  The  best  experience  ever.

  • Ann Waititu

    I know this might sound weird but I spent my valentine day in hospital and it was the most memorable so far.

    I fainted on the 13th and had to spend that night and the whole of 14th in hospital.

    When I woke up in the morning on Tuesday, I found my hospital room full of flowers and there was a voice recorder on the table with a label reading ‘listen yo me Ann.’ When I pressed play, I listened to 2mins 30sec of the sweetest msg poem Ive ever heard courtesy of my childhood friend Allan Karanja. Since he works far from Nairobi, he made sure that every hour from 9-5 there was a male nurse to give me a flower, a bar o chocolate and read me a poem as per his instructions. He also left an ipod with 350 of the best love songs which I listene to the whole day. There was a nurse whose job was only to cater for me the whole day and provide anything

    askd for

    This was the one day that I will live to remember for the rest of my life.

  • As compared to the rest this was very, very polite day being on a busy weekday as well. Had customed designed a Valentines Card for her which she actually loved very much. She also got me something nice as well.It was more or less a day of exchanging love gifts. The thing I love about her is that she has a very clean and loving heart. She accepts anything I do to her no matter how big or small. Her smile always make my day whenever and that also keeps me going even when the going is taff. Hats off….

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