Methanol-Related Fatalities in Jeddah, Saudi Arabia: A 5-Year Post-Mortem Multi-Matrix Study

Although alcohol consumption is prohibited in Saudi Arabia, methanol poisoning outbreaks continue to occur, largely through surrogate or non-beverage alcohols. To date, systematic forensic documentation of methanol-related fatalities in Saudi Arabia remains limited. This study presents a comprehensive post-mortem series of methanol-related deaths investigated in Jeddah and characterizes the demographic patterns, circumstances of death, post-mortem interval (PMI), and methanol distribution across multiple biological matrices. In total, 34 post-mortem cases with toxicologically confirmed methanol exposure were retrospectively examined. Methanol and ethanol levels in blood, urine, vitreous humor, bile, gastric contents, and selected tissues were quantified using a validated headspace gas chromatography-flame ionization detection method. Decedents were aged 18-73 years (median, 34.5 years), with a marked predominance of young-to-middle-aged men. PMI ranged 1-15 days (median, 2 days), and evidence of putrefaction was present in approximately one-third of the cases. Most deaths were classified as accidental and primarily occurred in private residences. Two distinct outbreak periods (2018 and 2022) were identified; values tended to be higher in 2018, but the differences were not statistically significant. NaF-preserved blood, urine, and vitreous humor were informative in non-decomposed cases, whereas vitreous humor and solid organs, particularly the liver and kidneys, retained quantifiable methanol in putrefied bodies. Ethanol was detected in a minority of cases and was considered a secondary or contributory finding. This study provides an important forensic baseline dataset for methanol-related fatalities in Saudi Arabia and underscores the need for continued surveillance and preventive measures.