Methanol Poisoning: An Autopsy-Based Study at the Tertiary Care Center of Uttarakhand, India

Aims and objective This study describes postmortem and histopathological findings to understand the internal progression of methanol poisoning. The study also aims to examine clinical, biochemical, and histological changes seen with methanol poisoning. Materials and methods The study describes the methanol poisoning tragedy that occurred in February 2019 in the Haridwar district of Uttarakhand. Ninety-one patients were admitted to the hospital, four were brought dead, four died within a few hours of admission (designated as early deaths), and four died between 10 and 45 days of hospitalization (designated as late deaths). A medicolegal autopsy was performed on all 12 deaths. Gross external and internal findings were noted, and routine viscera and blood were preserved and sent to Uttarakhand's Forensic Science Laboratory (FSL) to estimate methyl alcohol. A section of the optic nerve was taken from the optic chiasma for histopathological examination. Data were collected retrospectively from records. All data were tabulated and analyzed using Microsoft Excel version 2019. The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences (AIIMS), Rishikesh (249201), Uttarakhand, India. Results Methanol poisoning is a health-associated disaster in many regions of India. Autopsy, including histopathological examination, could elicit the adverse effects of methanol on different organs. Their mean age was 37.7 years (range 21-70), and 67% (n = 8) of all victims were in the age range of 30-50 years. The average methyl alcohol level reported among hospital deaths and brought dead was 116.08 mg/dl and 224.6 mg/dl, respectively. A blurred vision had been their most common complaint, identified in 75% (n = 6), followed by vomiting and abdominal pain, while 50% (n = 4) had features of respiratory insufficiency. Mean pH and bicarbonate levels among hospital deaths were 6.61 mmol/l and 6.18 mmol/l, respectively. An autopsy revealed signs of hypoxia in all cases. Internal organs were congested. Severe metabolic acidosis leading to the respiratory failure was the cause of death in early deaths. Cerebral and pulmonary edema consequent upon septicemic shock was the cause of late deaths. A case with the most extended survival duration showed cerebral edema with intracerebral hemorrhage. Cirrhotic liver, along with features of renal failure, was an additional internal finding in late deaths. Optic nerve histopathology showed no demyelination or axonal necrosis; however, mild edematous changes were evident. Conclusions Methanol poisoning is one of the manmade disasters in the developing world. There are various adverse effects of different organs and organ systems inside the body. Timely intervention and diagnosis can save several lives. The organ-directed meticulous autopsy can help autopsy surgeons in establishing the diagnosis and thus help the judiciary in delivering justice to the sufferers.