Emergency Medicine Australasia

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Medicine & Healthcare, Wiley-Blackwell

August 15, 2012

Toxic cocktail: warning to tourists in southeast Asia

Drinking complimentary cocktails at a popular tourist bar in Indonesia resulted in a young woman requiring hospital treatment for methanol poisoning, sparking a warning from doctors for tourists to be wary of potentially tainted drinks in southeast Asia.

Methanol is used as a fuel, a solvent, windscreen de-icer and antifreeze. If consumed, it can cause blindness, coma and death.

Today, methanol toxicity is seen infrequently in the developed world; however, it is still commonly seen in developing countries as a result of home-brewed alcohol.

A report published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine, describes a young tourist who developed sudden onset visual failure and rapid breathing two days after ingestion of a complimentary local drink called Arrack when travelling in Indonesia.

The 19-year-old backpacker consumed 8-10 complimentary cocktails containing a mixture of Arrack and fruit juice. She arrived in New Zealand 35 hours later suffering from shortness of breath.

She sought help later when her vision began to fail.  Although the woman survived, she has been left with permanent visual impairment.

In the case report, emergency physician Dr Paul Gee and colleague Dr Elizabeth Martin, from the Emergency Department at Christchurch Hospital, express concern about the number of methanol poisoning cases among tourists to Indonesia in recent years.

“An almost identical case was reported in an Australian tourist to Indonesia in 1992. An incident where 25 died from methanol poisoning in Indonesia occurred in 2009, and in recent months, an Australian nurse was poisoned by tainted arrack and another tourist died in similar circumstances,” the authors said.

“In the case reported now, it is likely that the woman was given a drink contaminated with methanol from an illegal distillation of ethanol.

“Arrack is a coconut flower, rice and sugarcane-based spirit common in Indonesia, which is produced commercially as well as illegally.” (Arrack is local to Indonesia and should not be confused with the Middle Eastern anise-flavoured liquor named “Arak”.)

Dr Gee and Dr Martin say this case highlights the risk of consuming alcohol of unverified origin in southeast Asia.

Early symptoms can be non-specific, and late presentation from methanol toxicity is not uncommon.