Pediatric ethanol intoxication is a toxic reaction to ethanol that occurs in children and teens following unintentional or intentional ingestion of alcoholic beverages or household products containing alcohol, such as hand sanitizer, mouthwash, cough and cold medicine, perfume, aftershave, and certain foods and beverages (eg, vanilla extract, certain energy drinks). Ethanol exposure can also occur through skin absorption, eye contact, or inhalation. Although not common, intentional intoxication of infant or child by a caregiver has been reported. Pediatric suicide attempt by alcohol overdose has also been reported.
Even a small quantity of ethanol can induce intoxication in toddlers and children. Ethanol intoxication can induce a severe reaction including altered mental status, bradycardia, hypoglycemia, hypothermia, hypotension, coma, seizures, respiratory depression, and even death. Other signs and symptoms of ethanol ingestion include lethargy, drowsiness, slurred speech, nystagmus, ataxia, eye irritation, nausea, vomiting, conjunctival injection, oral irritation, cough, abdominal pain, hematemesis, polyuria, hypovolemic dehydration, and a sweet fruity breath odor.
Related to ethanol, but more poisonous due to chemical additives, are denatured alcohol and highly toxic methanol and ethylene glycol. Isopropyl or rubbing alcohol is also chemically similar to ethanol, but produces acetone that accumulates in the liver.
Older children and adolescents may intentionally consume alcoholic beverages or products with a high concentration of alcohol on their own or with their peer group. These children and teens are at greater risk for habitual alcohol consumption, binge drinking, sexual assault, violent behavior, suicidal thoughts, pregnancy, poor academic achievement, motor vehicle accidents, and death by overdose.
Management calls for immediate emergency treatment. Patients may present with a crisis of hypoglycemia, hypothermia, hypovolemia, coma, obstructed respiration, or other life-threatening condition. Beyond this supportive care is recommended. It is not advised to perform gastric emptying or use activated charcoal on children for ethanol ingestion alone. The patient may require treatment for related physical injuries such as burns, fractures, bruises, sexual assault, and signs of child abuse and sexual assault. Use of ethanol products with the intention of self-harm calls for consultation with mental health professionals.
Reporting: It is crucial that any recognition or suspicion of abuse or neglect be followed by immediate reporting to appropriate authorities to safeguard the child from further injury. To report suspected abuse, the clinician should contact his/her state or local CPS agency. The national number, 1-800-4-A-CHILD, is available to help locate the regional department. If unsure whether to report, consultation with other health care professionals or CPS is recommended to help determine if the incident is reportable. It is important to remember that the duty to report requires only a reasonable suspicion that abuse has occurred and not certainty.
