Ethanol intoxication in children: Rapid overview of emergency management

To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links).

Clinical features

Ensure that "alcohol" ingested is ethanol and not another toxic alcohol (eg, methanol, ethylene glycol): clinical signs of toxic alcohol include a serum osmolal gap out of proportion to the ethanol level soon after ingestion, and development of severe anion gap metabolic acidosis

Ethanol ingestion in young children carries a significant risk for hypoglycemia

Common findings:

Vital signs – hypothermia, bradycardia, hypotension, and/or respiratory depression
Other – lethargy, coma, ataxia, slurred speech, vomiting, and/or sweet breath odor

Other findings:

Hypoglycemic seizures and death (especially young children)
Nystagmus
Mild to moderate hypovolemia
Signs of trauma or sexual assault (adolescents)

Diagnostic evaluation

Obtain fingerstick blood glucose in all patients with altered mental status and young children

Measure blood ethanol level*

Possible toxic alcohol ingestion: serum electrolytes, BUN, creatinine, serum osmolality, serum calcium, blood gas, serum methanol and ethylene glycol levels

Other studies based on clinical presentation^¶

Treatment

Secure airway and support breathing as needed

Treat hypoglycemia with 0.25 grams/kg IV dextrose bolus (maximum single dose 25 grams). Glucagon is ineffective for ethanol-induced hypoglycemia in children.^Δ

The volume and concentration of glucose bolus is infused slowly at 2 to 3 mL per minute and based upon age^Δ:

2.5 mL/kg of 10% dextrose solution (D10W) in infants and children up to 12 years of age (10% dextrose is 100 mg/mL)
1 mL/kg of 25% dextrose (D25W) or 0.5 mL/kg of 50% dextrose (D50W) in adolescents (25% dextrose is 250 mg/mL; 50% dextrose is 500 mg/mL)

After reversal of hypoglycemia, maintain blood glucose by administering continuous dextrose infusion with ¼ or ½ normal saline, depending upon maintenance sodium requirements, to maintain blood glucose greater than 60 mg/dL (3.33 mmol/L) or, in conscious patients who are able to drink and swallow safely, provide a regular diet^Δ

Treat hypovolemia with intravenous bolus of normal saline or lactated Ringer's solution 20 mL/kg (maximum 1 L), repeat as needed

Rewarm based on core body temperature

* All infants and young children with significant ingestion. May provide estimate of symptom duration in moderate to severely intoxicated adolescents.

¶ Refer to UpToDate topics on ethanol poisoning in children and adolescents.

Δ Refer to UpToDate topics on toxic effects of ethanol in children and UpToDate rapid overview and topics on management of hypoglycemia in children.

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Ethanol intoxication in children: Rapid overview of emergency management