Ethanol intoxication in children: Epidemiology, estimation of toxicity, and toxic effects
- Carl R Baum, MD, FAAP, FACMT
Carl R Baum, MD, FAAP, FACMT
- Associate Professor of Pediatrics
- Yale University School of Medicine
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The epidemiology, pharmacokinetics, and estimation of toxicity of ethanol intoxication in children are reviewed here. Evaluation and management of pediatric ethanol exposure are discussed separately (table 1). (See "Ethanol intoxication in children: Clinical features, evaluation, and management".)
Despite its abuse potential, ethanol is broadly tolerated in a social context and is therefore ubiquitous in society. It is available in a multitude of alcoholic beverages but also concentrated in household products (eg, vanilla extract, mouthwash, perfume/cologne) (table 2).
Young children — Children under six years of age, particularly toddlers, often ingest ethanol when their exploratory behaviors lead them to unattended alcoholic beverages or to unsecured household products with high ethanol concentrations (table 2).
Thousands of ethanol exposures in children under six years of age are reported to poison control centers annually in the United States . Ethanol-containing products other than alcoholic beverages (eg, perfumes, colognes, mouthwash, medicinals, ethanol based hand sanitizers) account for 85 to 90 percent of these exposures [1-5]. In many instances, these exposures result in little to no toxicity . However, Infants and young children are prone to profound hypoglycemia, coma, and hypothermia despite ingesting relatively small amounts of ethanol [2,7-10]. Deaths have been reported .
Rarely, a caretaker may intentionally give ethanol to quiet an infant or young child or as part of a pattern of physical abuse [2,11].
- Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila) 2011; 49:910.
- Vogel C, Caraccio T, Mofenson H, Hart S. Alcohol intoxication in young children. J Toxicol Clin Toxicol 1995; 33:25.
- Miller, M, Borys, D, Morgan, D. Alcohol-based hand sanitizers and unintended pediatric exposures: a retrospective review. clin Pediatr 2009; 48:429.
- Engel JS, Spiller HA. Acute ethanol poisoning in a 4-year-old as a result of ethanol-based hand-sanitizer ingestion. Pediatr Emerg Care 2010; 26:508.
- Valeur KS, Hertel SA, Lundstrøm KE, Holst H. Safe excipient exposure in neonates and small children - protocol for the SEEN project. Dan Med J 2017; 64.
- Mrvos R, Krenzelok EP. Pediatric ingestions of hand sanitizers: debunking the myth. Pediatr Emerg Care 2009; 25:665.
- Selbst SM, DeMaio JG, Boenning D. Mouthwash poisoning. Report of a fatal case. Clin Pediatr (Phila) 1985; 24:162.
- Ricci LR, Hoffman SA. Ethanol-induced hypoglycemic coma in a child. Ann Emerg Med 1982; 11:202.
- Edmunds SM, Ajizian SJ, Liguori A. Acute obtundation in a 9-month-old patient: ethanol ingestion. Pediatr Emerg Care 2014; 30:739.
- Rayar P, Ratnapalan S. Pediatric ingestions of house hold products containing ethanol: a review. Clin Pediatr (Phila) 2013; 52:203.
- Dine MS, McGovern ME. Intentional poisoning of children--an overlooked category of child abuse: report of seven cases and review of the literature. Pediatrics 1982; 70:32.
- Jernigan DH. Global status report: alcohol and young people.World Health Organization. http://www.who.int/substance_abuse/publications/alcohol/en/index.html (Accessed on December 03, 2008).
- Drinking in America: Myths, realities, and prevention policy. US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, Washington, DC 2005. http://www.udetc.org/documents/Drinking_in_America.pdf (Accessed on December 03, 2008).
- Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ 2012; 61:1.
- Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. Office of Applied Studies 2007. http://dawninfo.samhsa.gov/pubs/edpubs/default.asp (Accessed on December 03, 2008).
- Alcohol involvement in fatal motor vehicle traffic crashes, 2003. National Highway Traffic Safety Administration, National Center for Statistics and Analysis, Springfield, VA 2005. http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2005/809822.pdf (Accessed on December 03, 2008).
- Centers for Disease control and Prevention. Quick stats: Underage drinking. http://www.cdc.gov/alcohol/quickstats/underage_drinking.htm (Accessed on December 03, 2008).
- Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007; 119:76.
- The Surgeon General's call to action to prevent and reduce underage drinking. U.S. Department of Health and Human Services 2007. http://www.surgeongeneral.gov/topics/underagedrinking/ (Accessed on December 03, 2008).
- National Research Council and Institute of Medicine. Reducing underage drinking: A collective responsibility. Bonnie RJ, O'Connell ME (Eds), National Academies, Washington 2004. http://www.nap.edu/catalog.php?record_id=10729 (Accessed on March 08, 2008).
- Norberg A, Jones AW, Hahn RG, Gabrielsson JL. Role of variability in explaining ethanol pharmacokinetics: research and forensic applications. Clin Pharmacokinet 2003; 42:1.
- Linnoila M, Mattila MJ, Kitchell BS. Drug interactions with alcohol. Drugs 1979; 18:299.
- Kleinschmidt KC. Ethanol. In: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, 4th, Shannon MW, Borron SW, Burns MJ. (Eds), Saunders, Philadelphia 2007. p.591.
- Yip L. Ethanol. In: Goldfrank's Toxicologic Emergencies, 8th, Flomenbaum NE, Goldfrank LR, Hoffman RS, et al. (Eds), McGraw-Hill, New York 2006. p.1147.
- Erickson TB, Brent J. Toxic alcohols. In: Pediatric Toxicology: Diagnosis and management of the poisoned child, Erickson TB. (Ed), McGraw-HIll, New York 2005.
- Caballería J. Current concepts in alcohol metabolism. Ann Hepatol 2003; 2:60.
- Tran MN, Wu AH, Hill DW. Alcohol dehydrogenase and catalase content in perinatal infant and adult livers: potential influence on neonatal alcohol metabolism. Toxicol Lett 2007; 169:245.
- Lieber CS. The discovery of the microsomal ethanol oxidizing system and its physiologic and pathologic role. Drug Metab Rev 2004; 36:511.
- Lopez GP, Yealy DM, Krenzelok EP. Survival of a child despite unusually high blood ethanol levels. Am J Emerg Med 1989; 7:283.
- Donovan JE. Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments. Pediatrics 2009; 123:e975.
- Osterhoudt KC, Burns Ewald M, Shannon M, Henretig FM. Toxicologic emergencies. In: Textbook of Pediatric Emergency Medicine, 6th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.965.
- Riordan M, Rylance G, Berry K. Poisoning in children 4: household products, plants, and mushrooms. Arch Dis Child 2002; 87:403.
- Ethanol in liquid preparations intended for children. Pediatrics 1984; 73:405.
- Leung AK. Ethyl alcohol ingestion in children. A 15-year review. Clin Pediatr (Phila) 1986; 25:617.
- Weller-Fahy ER, Berger LR, Troutman WG. Mouthwash: a source of acute ethanol intoxication. Pediatrics 1980; 66:302.
- Crabb DW, Bosron WF, Li TK. Ethanol metabolism. Pharmacol Ther 1987; 34:59.
- Madison LL. Ethanol-induced hypoglycemia. Adv Metab Disord 1968; 3:85.
- Marks V. Alcohol and carbohydrate metabolism. Clin Endocrinol Metab 1978; 7:333.
- Lamminpää A. Alcohol intoxication in childhood and adolescence. Alcohol Alcohol 1995; 30:5.
- Young children
- Preteens and teenagers
- Absorption and distribution
- Duration of symptoms
- ESTIMATION OF TOXICITY
- Estimation of serum ethanol
- Toxic dose
- - Infants and young children
- - Older children and adolescents
- TOXIC EFFECTS
- Central nervous system (CNS) depression
- Ethanol-induced hypoglycemia
- Other effects
- ADDITIONAL RESOURCES