Every few months we hear news of people dying after consuming locally-produced toxic liquor or kachi sharab.
Just two weeks back two fishermen died in Karachi’s Ibrahim Hyderi after consuming toxic liquor.
Five other fishermen underwent treatment at Jinnah Postgraduate Medical Centre, Dr Seemin Jamali told SAMAA Digital.
Local liquor can be much more dangerous than the imported kind as it does not undergo a multiple distillation process and is poorly regulated. If care is not taken in the distillation process and the proper equipment is not used, harmful impurities such as fusel alcohol, lead from plumbing solder, and methanol can become concentrated enough to reach toxic levels.
Types of toxic liquor
1) Denatured alcohol is also called methylated spirits. It is ethanol that has additives to make it poisonous, foul smelling, nauseating, and taste bad, to discourage recreational consumption. The main additive has traditionally been 10% methanol, giving rise to the term “methylated spirits”. This is what people from low-income backgrounds drink. The sellers mix water and cough syrups in it.
2) Minorities in Pakistan have a legal quota for alcohol purchase. Many of them sell their alcohol and mix methylated spirits in it. This is more expensive than the first type.
3) Illegal brewing in homes by local and old methods. It is not possible to control the percentage of ethanol in such wines. It can cause severe consequences including death due to the high ethanol content. This is known as country or desi (country) sharab (wine). It is more expensive than the above two types.
4) Kachi sharab is the most common form of illegal toxic liquor in Pakistan. It is being produced by the illegal brewers and many poor and working-class Pakistanis continue to lose their lives to it. It is a major problem of south Punjab and Sindh. It is manufactured using methylated spirit, thinner, alcohol containing cough syrups, and Mandrax tablets (methaqualone: a sedative and hypnotic drug). They mix all these ingredients in mineral water. The mafia involved in this business has labels and empty bottles from national and international brands. They even have a system that puts bottle caps with seals.
It is not possible to differentiate illegal toxic liquor from authentic wines.
Why does kachi sharab cause sudden death?
Methanol, known as methyl alcohol or wood alcohol, is a chemical with the formula CH3OH. Methanol is a light, volatile, colourless, flammable liquid with a distinctive odor very similar to, but slightly sweeter than that of ethanol, and produced as a by-product of the distillation of wood. It is used as antifreeze, solvent, fuel, and denaturant for ethanol. Methanol ingestion can cause severe metabolic disturbances, blindness, permanent neurologic dysfunction, and death. It is converted to a highly toxic formic acid in the human body.
These toxic metabolites like formaldehyde and formic acid cause metabolic acidosis (imbalance of body pH), blindness, cardiovascular instability, and death. Minimal lethal dose of methanol in humans has been assumed to be 1 gram per kg of body weight. Methanol is a CNS depressant. It is then converted to formaldehyde which forms formic acid. Formic acid inhibits mitochondrial cytochrome c oxidase, causing the symptoms of hypoxia (oxygen shortness) at the cellular level and metabolic acidosis.
The interventionist and head of the ICU at Ziauddin Hospital North Nazimabad Dr Quratulain said that sudden death occurs because of acute liver failure.
Signs and symptoms of methanol poisoning
Central nervous system depression leads to headaches, dizziness, nausea, lack of coordination, and confusion. Once the initial symptoms have passed, the second set of symptoms arise10 to 30 hours after the initial exposure to methanol. These include blurring or complete loss of vision and acidosis. These symptoms result from the accumulation of toxic levels of formic acid in the blood and may progress to death by respiratory failure. MRI findings in methanol poisoning are characteristic and include hemorrhagic putaminal necrosis (bleeding in a part of the brain which leads to cell death), subcortical and deep white matter lesions, cerebral and cerebellar cortical lesions, and midbrain lesions.
How to treat alcohol poisoning
If you’re in a situation where you suspect someone around you has methanol poisoning, you should call for professional help immediately. While you wait for professional care here’s how to take care of the patient:
•If they’re unconscious, gently turn the person on their side to prevent them from choking on vomit.
•If they’re conscious, encourage the person to lay on their side in a safe place until help arrives.
•If they’re able to swallow, encourage the person to drink water.
•Stay with the person until medical help arrives.
Emergency medical technicians will take the intoxicated person to the hospital. There, professionals will:
•carefully monitor vital signs
•prevent breathing or choking problems with a breathing tube that opens the airways
•give oxygen therapy
•give intravenous (IV) fluids to prevent dehydration
•give vitamins and glucose (sugar) to prevent complications
•fit a catheter, which allows urine to drain into a bag, so they don’t wet themselves
•pump the stomach (gastric lavage) to minimize the body’s absorption of already ingested alcohol
•give activated charcoal to further minimize the body’s absorption of alcohol
How kachi sharab is made
A local brewer from district Sanghar, said that the locals use jaggery (gur) to ferment and produce liquor. “Our local liquor is different from kachi sharab made from methyl spirit”, he added.
The process of distillation, however, remains outdated and unchecked.
Information from a local source revealed that jaggery, sugarcane, rotten fruits, and kikar ki chall (outer layer of local tree) are the raw materials for the production of local “white-lighting”.
The process involves putting raw material in a utensil, burring in a deep dug tunnel underground covered for a couple of days. Then the container is put in the middle of the barrel and heated from the lowest portion and covered with a container of cold water. The pot in the middle is attached to another bowl via a pipe. The pipe carries the evaporated droplets from fermented content to the bowl and eventually, the local liquor is made.
Hunza water is domestically produced moonshine in the Northern Areas of the country; the recipe passes from generation to generation. The method of production is overall similar to the above mentioned regional hooch.
Local moonlight is sold in the purest form; it is made in villages and small towns. The big cities, however, put toxic ingredients to increase the potency and quantity. Hence, more profit would be generated over large volumes. There’s no check and balance by higher authorities.
The local names for the locally produced intoxicants are Tharra, Point, Kopi, Nip and Qauter.
Kopi and Tharra are the most toxic ones made with sedatives and spirits over a certain temperature and sold for a mere Rs100 in plastic bags. These two are responsible for most deaths reported so far.
The limited quota and lack of law enforcement encourages the sales of such intoxicants; lack of chemical balance and greed of the producer adding toxics further make consumers prone to life-threatening risks.
Dr Kaleem Sheikh, ex-police additional officer, said that authorized places to sell liquor in the local language are called as “gutta”. These places are widespread all over the country. Wine shops like these were intended to provide booze to minorities. As per sharia law, Pakistan is prohibited to serve liquor to Muslim citizens. This leads to a flourishing black market.
According to news in the past, at least 23 people have died and 13 are battling for their lives at the hospital after having consumed low-quality homemade liquor in Karachi on October 8, 2014, doctors said.
The liquor, locally known as “kachi sharab,” is prepared at unlicensed small breweries located in private houses, particularly in shanty towns in many parts of Pakistan. The liquor becomes toxic due to the excessive use of chemicals in order to increase its potency. It is responsible for hundreds of deaths every year.
It is available at less than half the price of original brands and is generally consumed by those too poor to afford commercial brands.
A bill banning the consumption of alcoholic beverages is currently being debated in the Pakistani parliament.
No data regarding Pakistan is available as drinking alcohol is officially prohibited for Muslims in Pakistan, although locally-produced liquor is sold in the black market.