On August 18, Upendrasinh Chandrasinh Gohil, 25, became the first casualty of the latest liquor tragedy in the ‘dry state’ of Gujarat, where a prohibition policy has been in force since the 1960s. Within six days, the death count of the Bhavnagar liquor tragedy has reached 13. A total of 60 people have been affected after consumption of the methanol-laced drink.The Bhavnagar tragedy comes four years after 42 people died across three districts of Gujarat in a “lattha kaand” – a Gujarati expression used to refer to poisoning due to contaminated liquor. Before 2022, hooch tragedies in Gujarat claimed 148 lives in Ahmedabad in 2009, 132 in Vadodara in 1989, and 101 in Ahmedabad in 1977.What is a ‘lattha kaand’?In Gujarat, a ‘lattha kaand’ refers to loss of lives or hospitalisations due to consumption of illegally manufactured liquor. While licensed liquor manufacturers use ethyl alcohol, hooch makers replace it with cheap ingredients such as industrial-grade Methanol, highly toxic to the human body.In most cases, this drink is illegally marketed and sold as country liquor or moonshine. But in the Bhavnagar incident, this Methanol-laced liquor was filled into bottles of a popular brand of Indian Made Foreign Liquor (IMFL) using forged stickers and caps and sold to unwitting victims. Police believe that 25 cartons comprising a total of 300 bottles of this toxic concoction were sold to retail bootleggers.This means that at 750 ml per bottle, 225 litres of this poisonous drink were in circulation. Forensic reports have found that this liquor contained 38.59 per cent Methanol. In comparison, the toxic drink that led to the 2022 tragedy was 98 per cent Methanol.What are the symptoms?The Indian Express spoke to Dr Sunil Panjwani, Head of the Department of General Medicine, at Sir Takhtasinhji General Hospital in Bhavnagar, whose team has treated patients after this tragedy, and the one in 2022.“The symptoms start with nausea, vomiting, blurring of vision, and breathlessness. There are also neurological symptoms such as clumsiness. Generally, symptoms start after 2-4 hours. But if a large amount of the tainted liquor was consumed, they could begin immediately… Breathlessness and kidney (acidosis) symptoms begin after 10-12 hours.”Story continues below this adIn the Bhavnagar case, most victims reached the hospital 48 hours after they consumed the toxic drink. “The first patient with a history of consumption was admitted in a private hospital and then sent to us on August 18. Three more came by evening. This was when we came to know that adulterated alcohol was in circulation,” said Dr Panjwani.How ‘Patient Zero’ was identifiedWhen the doctors suspected that a hooch tragedy may have occurred, it was found that a patient with symptoms similar to those of the methanol poisoning victims had been admitted to the hospital a day earlier.Kartik Ashwin Makwana (40), identified as ‘patient zero’, was admitted to Sir Takhtasinhji General Hospital on August 17. But he allegedly did not inform doctors about drinking the toxic liquor. “So we asked his relatives again and found out that he had also consumed it. We added him retrospectively to the list of victims,” said Dr Panjwani. Makwana died later.What does Methanol do to humans?The metabolic breakdown of Methanol in the human body creates Formaldehyde (used in embalming fluid) and then the highly corrosive Formic Acid (used in rust removers), causing acidosis in the liver. In extreme cases, this leads to multi-organ failure and death.Story continues below this adA person’s metabolic rate, amount of the toxic drink consumed, and the time lapse before treatment begins contribute to the medical outcome. Take the case of Sanjay Lakshman Dodiya, who went from Bhavnagar to Surat and then felt the ill effects of the toxic drink. He was declared brain dead two days before he succumbed to cardiac arrest on August 23.According to the FIR, the toxicology report stated that Makwana had 0.0847 per cent W/V (weight per volume percentage) of Methanol in his blood. This, when converted to the clinical unit of milligrams per decilitre, comes to 84 mg of Methanol per 100 ml of his blood, said doctors.To put this into context, according to Indian law, 30 mg of Blood Alcohol Content per 100 ml of blood is enough to get a citation for Driving Under the Influence. In the case of 25-year-old Upendrasinh Chandrasinh Gohil, the first victim, the Methanol concentration was 0.0773 per cent W/V – 77 mg of Methanol per 100 ml of his blood.Dr Panjwani said, “This is not pure laththa (hooch). Pure hooch is more than 70 per cent Methanol… In this case, there was Ethanol too… which is an antidote against Methanol.”Story continues below this adTreatment protocols: A race against timeEthanol is among two treatment protocols used to treat Methanol poisoning, the other being Fomepizole, an intravenous drug used in both Methanol and Ethylene Glycol poisoning cases and much more potent than Ethanol.In the Bhavnagar tragedy, many patients started going to hospitals only after it was reported in the news, and many of them were taken to hospitals by the police.Dr Panjwani said, “Both Ethanol and Fomepizole stop Methanol from being metabolised into its other states of Formaldehyde and Formic Acid.”“If a patient comes very early, Fomepizole is administered. But once the Methanol has had time to metabolise into Formic Acid, chances of the drug working get reduced. When Formic Acid has been formed, we administer Folinic Acid and Folic Acid (which breaks down Formic Acid into carbon dioxide and water).”Story continues below this adDr Kairavi Joshi, Medical Superintendent of the hospital, said they received supplies of Fomepizole from Ahmedabad. The state government has procured more and distributed them to private hospitals too.Hospital officials said those affected are undergoing dialysis through the day. In a silver lining, some patients have also been discharged. Dr Panjwani said they were admitted and checked for poisoning. “We conducted the Absolute Basophil Count blood test every 6 hours. It tells us two things. One is the blood pH level that confirms acidosis. The other is the level of bicarbonate – if it is low, the patient needs dialysis. If three consecutive tests in 18 hours come back normal, there are no clinical symptoms, and the patient has good vital signs, they can be discharged.”Why delay in reporting Methanol deaths?On the night of August 19, 42-year-old teacher Hitesh Dileep Parmar was found dead at his Bhavnagar home. His body was slumped next to his bed, and a glass of the poisonous liquor had spilt in front of him.As the hooch tragedy claimed one life after another, there was a distinct lag by the district administration in confirming the deaths. The official reason cited was that the forensic lab had to confirm that the cause of death was Methanol poisoning.Story continues below this adThe Indian Express spoke to a senior forensic expert. “In poisoning cases, you cannot identify the poison itself. You reach an opinion when you get FSL reports of toxicology analysis. We take samples of stomach, liver, kidneys and blood and send them for testing. Whether it shows up in the results also depends on the concentration of the poison in the body,” the doctor said, requesting anonymity.“Results of the toxicology report also depend on whether the patient has directly died due to a lethal dose of the poison, or they have undergone treatment, as the latter would also dilute the amount of poison in the body and only trace amounts may be found during postmortem.”